From this article you will find out who is being prescribed uterine artery embolization, what is the procedure, how it is performed. Preparation for surgery, postoperative period, possible complications and further life. Contraindications.
Indications and contraindications for operation
Uterine artery embolization( EMA) is a minimally invasive surgical procedure used for uterine myoma( benign tumor) and abundant uterine blood flowtations.
In this procedure, a special drug is injected through the catheter into the arteries that supply blood to the nodes of the myoma, to block them. Thus, the tumor stops blood supply and in the future decreases in size. The same procedure allows you to stop heavy bleeding.
Gynecologist prescribes the operation, the endovascular surgeon conducts.
Indications and contraindications for
Embolization of uterine arteries in uterine myomas is used as an alternative to the removal of fibroids( tumors).
The procedure can also be used as a preparation for the removal of fibroids to prevent possible surgical complications associated with bleeding.
| When the EMA is prescribed | The procedure is not performed with |
|---|---|
| Patients with growing uterine myoma, whose size corresponds to 7 weeks of gestation and more( provided that there are no serious pathologies of the ovaries, endometrium, cervix) | The presence of inflammatory process in the body, especially in the organs of smallpelvis |
| Women with indications for removal of the uterus if they want to preserve this organ and reproductive function | Allergies to contrast agents and other drugs containing iodine |
| To those who are prescribed myoMyoma, if there is a risk of bleeding | Myoma, whose size corresponds to less than 7 weeks of gestation. |
| With uterine bleeding, when other treatments have proved ineffective. |
already become pregnant. Types of uterine fibroids The main advantage of EMA is the ability to save the uterus. The disadvantage compared to hysterectomy( removal of the organ) - the risk of relapse remains.
Preparation for operation
Before going to the procedure, it is necessary to finish the course of treatment with hormonal preparations, including those that the doctor prescribed for the fight with myoma. Taking hormonal medications reduces the effectiveness of the operation.
As for the other drugs( including for the treatment of cardiovascular diseases), tell us about their admission to the doctor. Many of them will need to be canceled 3-10 days before the operation.
Analyzes, the results of which must be carried on hands:
| Analysis of | The validity of the result of the analysis |
|---|---|
| General blood test | 14 days |
| Blood tests for coagulation, for sugar, for proteins, electrolytes, markers of kidney and liver diseases. | 14 days |
| Blood test for infection: HIV, RW( syphilis), HbsAg( hepatitis B), HCV( hepatitis C). | 90 days |
| General urine test | 14 days |
| Smear from the vagina | 30 days |
| Scraping from the cervix | Year |
| Diagnostic scraping of the uterine cavity | Year |
| Ultrasound of the pelvic organs, if necessary - MRI of the pelvic organs | 90 days |
| Fluorography | Year |
| Cardiogram | 10 days |
On the day of surgery, it is better not to have breakfast. Drink water can be up to 1-2 hours before the operation.
The essence of the procedure and its implementation
The patient is hospitalized the day before the embolization.
Half an hour before the intervention, a sedative injection can be made if the woman is psychologically difficult to tolerate medical procedures.
The operation is performed under local anesthesia.
Procedure:
- The doctor inserts a 1.5 mm diameter catheter into the femoral artery through a puncture or a small incision.
- Contrast substance is introduced into the catheter, which allows to control the process of the operation by X-ray.
- Through a catheter into the arteries that supply blood to the nodes of myoma, a special drug is injected to block them. Thus, the tumor stops blood supply and in the future decreases in size.
The whole process takes 20 to 90 minutes, depending on the individual characteristics of the circulatory system of a woman.
The process of embolization of uterine arteries Postoperative period, possible complications of
In a hospital, you will be 2-3 days after embolization of uterine myoma.
Immediately after the operation, a pressure bandage will be applied to the thigh to prevent extensive hematoma and bleeding at the artery puncture site. Take it out in 3 hours.
To prevent complications( primarily associated with the puncture of the femoral artery) during the 12 hours after the operation, observe bed rest and do not bend the leg in the hip joint.
Side effects of surgery that arise in normal and worried most patients:
- pulling pains in the lower abdomen;
- elevated body temperature;
- uninfluous spotting from the vagina;
- urination disorders;
- nausea, vomiting.
They usually pass for 1-4 days. To eliminate pain, the patient is prescribed, if desired, analgesics. All other side effects can also be eliminated by symptomatic medication.
Dangerous complications occur in no more than 1% of cases. These are infectious diseases of the uterus, ischemia of the uterus( insufficient uterine circulation), bleeding from the femoral artery, thrombosis of the femoral artery.
The long life of
A woman can return to work and her usual life just a week after the operation.
For 7 days after embolization of uterine fibroids, physical activity and weight lifting( more than 3 kg) are not recommended. Also at this time you can not attend massage sessions, swimming pool, sauna, take a bath, swim in the water, sunbathe, including in the solarium.
For further life( after 7-10 days), the EMA does not impose any restrictions. You can exercise, work on the old job, have sex life and even in the future have a baby in the absence of other contraindications in pregnancy and childbirth.
Effect on the menstrual cycle
It is noted that in most women who underwent surgery, bloody discharge during critical days became less abundant.
In 3% of operated on during 3-6 months after the procedure, menstruation irregular, less often - absent.
In single cases, patients older than 40 years after the procedure comes to menopause. However, the relationship between the onset of menopause and uterine artery embolization has not been studied.
The possibility of childbearing
In medicine, many cases are known where a woman who underwent EMA safely nurtured and gave birth to healthy children.
There is also evidence that women who had previously performed an EMA had serious complications of pregnancy: placenta increment, premature placenta separation, early delivery, intrauterine fetal death.
However, there is no direct relationship between these cases and the fact that the woman underwent EMA.
The effect of uterine artery embolization on further pregnancy and childbirth is still being studied.
Advantages and disadvantages of EMA compared with the removal of the uterus
There is a more radical method of treatment - removal of the uterus Compared with the removal of the uterus, the EMA also has such advantages:
- no risk of complications such as peritonitis, seam divisions;
- less prolonged recovery period( week compared to 3 months after hysterectomy);
- the possibility, if desired, to lead a sexual life within a week after the operation;
- preservation of the body, and hence, the possibility of procreation in the future.
The main disadvantage is less efficiency. After removal of the uterus, the risk of recurrence is zero. But after EMA, in 7,5% of patients there is a repeated tumor within the first year, and at 15-20% - during the further life.
Prognosis, risk of relapse
With regard to complications, the prognosis after surgery is favorable. Hazardous consequences occur in less than 1% of cases.
Also, the operation does not impose a negative imprint on the woman's future life, so it can be called safe.
It is carried out without using general anesthesia and without cuts( use only a puncture of the femoral artery).These are also indubitable pluses.
The operation gives good results. Depending on the size of the nodes of the myoma, they either decrease by more than 50%, or disappear.
Symptoms stop worrying a woman in 95% of cases.
