EXPERIENCE OF MANAGEMENT OF POSTEMBOLIZATION SYNDROME IN PATIENTS WITH UTERINE FIBROIDS
DOI:
https://doi.org/10.11603/24116-4944.2020.2.11850Keywords:
uterine artery embolization, uterine fibroids, postembolization syndromeAbstract
The aim of the study – to optimize the management of the postoperative period in patients with uterine fibroids after UAE.
Materials and Methods. The clinical documentation of 32 patients with uterine fibroids who underwent UAE in one of the private clinics in Kyiv and were under our supervision in the postoperative period was analyzed. The mean age of patients was (39.75±2.19) years. Anesthesia was chosen by the patient – 28.125 % (n=9) patients chose epidural anesthesia, 21.875 % (n=7) – intravenous sedation and 50 % (n=16) of UAE was performed under intravenous anesthesia with spontaneous breathing. All patients in the postoperative period received trimeperidine, paracetamol, and dexketoprofen for analgesia, and metronidazole and cefuroxime were given as antibacterial therapy. For outpatient treatment, all patients were prescribed tableted metronidazole and Cefuroxime, the duration of admission was 10 days. For the purpose of pain relief, the patients were offered rectal suppositories with diclofenac or tableted Lornoxicam or Ibuprofen, depending on the manifestations of the pain syndrome. To prevent ascending infection, the patients received vaginal suppositories with Lactobacillus acidophilus 2 times a week for 1 month.
Results and Discussion. After UAE, the average pain score on the numerical pain rating scale (1 to 10) for 2 days after UAE was (4.06±0.59) points. The average duration of hospitalization after UAE was (2.5±0.25) days and 28.12 % (n=9) of patients were forced to spend up to 3 additional days at home for rehabilitation.
Conclusions. UAE has good tolerability and short rehabilitation time. The duration of hospitalization and rehabilitation after UAE is comparable to that of laparoscopic surgery. Satisfactory level of pain is achieved by performing UAE under general intravenous anesthesia or epidural anesthesia, and outpatient antibiotic therapy (up to 10 days), anti-inflammatory therapy with vaginal and oral probiotic drugs and prevention of septic complications.
References
Dehbozorgi, A., Frenette, A., Alli, A., Ash, R., & Rohr, A. (2020). Uterine artery embolization: background review, patient management, and endovascular treatment. J. Radiol. Nurs., DOI: https://doi.org/10.1016/j.jradnu.2020.07.007.
Moss, J., & Christie, A. (2016). Uterine artery embolization for heavy menstrual bleeding. Women’s Health, 12 (1), 71-77.
Keung, J.J., Spies, J.B., & Caridi, T.M. (2018). Uterine artery embolization: a review of current concepts. Best Pract. Res. Clin. Obstet. Gynaecol., 46, 66-73.
Manyonda, I., Belli, A.M., Lumsden, M.A., Moss, J., McKinnon, W., Middleton, L.J., ..., & McPherson, K. (2020). Uterine-artery embolization or myomectomy for uterine fibroids. N. Engl. J. Med., 383 (5), 440-451.
Yoon, J.K., Han, K., Kim, M.D., Kim, G.M., Kwon, J.H., Won, J.Y., & Lee, D.Y. (2018). Five-year clinical outcomes of uterine artery embolization for symptomatic leiomyomas: an analysis of risk factors for reintervention. Eur. J. Radiol., 109, 83-87.
de Bruijn, A.M., Ankum, W.M., Reekers, J.A., Birnie, E., van der Kooij, S.M., Volkers, N.A., & Hehenkamp, W.J. (2016). Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am. J. Obstet. Gynecol. Surv., 71 (11), 653-655.
McLucas, B., & Voorhees III, W.D. (2015). The effectiveness of combined abdominal myomectomy and uterine artery embolization. Int. J. Gynecol. Obstet., 130 (3), 241-243.
Llewellyn, O., Patel, N.R., Mallon, D., Quinn, S.D., & Hamady, M. (2020). Uterine Artery embolisation for women with giant versus non-giant uterine fibroids: a systematic review and meta-analysis. Cardiovasc. Intervent. Radiol., 43 (5), 684-693.
Babaei, M.R., Moghaddam, S.A., Farajnejad, K., & Rajabzadeh, A. (2019). Uterine artery embolization in the treatment of symptomatic leiomyoma: effect on ovarian function, clinical symptoms and its complications. Cardiovasc. Intervent. Radiol., 43 (5), 684-693.
Bérczi, V., Valcseva, É., Kozics, D., Kalina, I., Kaposi, P., Sziller, P., ..., & Botos, E.M. (2015). Safety and Effectiveness of UFE in Fibroids Larger than 10 cm. Cardiovasc, Interv. Radiol., 38 (5), 1152-1156.
McLucas, B., Voorhees III, W.D., & Snyder, S.A. (2018). Anti-Müllerian hormone levels before and after uterine artery embolization. Minim. Invasive Ther. Allied Tech., 27 (3), 186-190.
El Shamy, T., Amer, S.A., Mohamed, A.A., James, C., & Jayaprakasan, K. (2020). The impact of uterine artery embolization on ovarian reserve: A systematic review and meta-analysis. Acta Obstet. Gynecol. Scand., 99 (1), 16-23.
Chen, W.H., Huang, K.H., & Kung, F.T. (2020). Effects of uterine artery occlusion during myomectomy on ovarian reserve: Serial follow-up of sex hormone levels, ultrasound parameters and Doppler characteristics. J. Obstet. Gynaecol. Res., 46 (5), 752-758.
Torre, A., Fauconnier, A., Kahn, V., Limot, O., Bussierres, L., & Pelage, J.P. (2017). Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors. Eur. Radiol., 27 (7), 2850-2859.
McLucas, B., Voorhees III, W.D., & Elliott, S. (2016). Fertility after uterine artery embolization: a review. Minim. Invasive Ther. Allied Tech., 25 (1), 1-7.
Sheikh, G.T., Najafi, A., Cunier, M., Hess, T.H., & Binkert, C.A. (2020). Angiographic detection of utero-ovarian anastomosis and influence on ovarian function after uterine artery embolization. Cardiovasc. Intervent. Radiol., 43 (2), 231-237.
van Overhagen, H., & Reekers, J.A. (2015). Uterine artery embolization for symptomatic leiomyomata. Cardiovasc. Intervent. Radiol., 38 (3), 536-542.
Graif, A., Leung, D.A., McKenna, G., Patel, K.D., Holmes, L.E., & Grilli, C.J. (2020). Evaluation of the effect of routine antibiotic administration after uterine artery embolization on infection rates. J. Vasc. Intervent. Radiol., 31 (8), 1263-1269.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Actual Problems of Pediatrics, Obstetrics and Gynecology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms:
1. The authors reserve the right to authorship of the work and pass the journal right of first publication of this work is licensed under a Creative Commons Attribution License, which allows others to freely distribute the work published with reference to the authors of the original work and the first publication of this magazine.
2. Authors are entitled to enter into a separate agreement on additional non-exclusive distribution of work in the form in which it was published in the magazine (eg work place in the electronic repository institution or publish monographs in part), provided that the reference to the first publication of this magazine.
3. Policy magazine allows and encourages authors placement on the Internet (eg, in storage facilities or on personal websites) manuscript of how to submit the manuscript to the editor and during his editorial processing, since it contributes to productive scientific discussion and positive impact on the efficiency and dynamics of citing published work (see. The Effect of Open Access).
