New Options Can Spare Women From Hysterectomy

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March 28, 2000 (San Diego) -- Doctors at Stanford University are using established techniques in new ways to treat one of the most common gynecologic complaints as well as one of the most serious obstetrical conditions. Researchers say these procedures can spare women from having hysterectomies, either to prevent problems from uterine fibroids or to spare their lives when they hemorrhage after delivering a baby.

Mahmood Razavi, MD, and his colleagues combined two techniques to treat 10 patients who had a high risk of hemorrhaging during childbirth, which can be fatal. The standard treatment in these cases, if medications fail, is for doctors to remove the uterus. In this study, Razavi and his co-workers inserted a few tiny balloons through a catheter into the groins of these patients just before delivery. They then moved the balloons up to some arteries in the uterus.

"Then the obstetrician delivers the baby, and if the patient bleeds, we inflate the balloons, which instantaneously blocks the blood flow and stops the bleeding," Razavi tells WebMD. This gives doctors time to perform the second part of the procedure: injecting a harmless substance called Gelfoam into the bleeding arteries to block them off.

That process, known as embolization, takes 20-30 minutes, Razavi says. The balloons are used to stop the bleeding first, he says, because "we can't let the patient bleed for that period of time." So far, 10 women have undergone this two-step procedure, and the uterus was spared in nine.

"This procedure could easily be available in community hospitals, because these are fundamental techniques that use equipment we can just pull off the shelves," says Razavi, an assistant professor of radiology at Stanford University. Since it requires close collaboration between an obstetrician and an interventional radiologist, "the biggest barriers are awareness on the part of the obstetrician and the willingness of the radiologist to get up in the middle of the night, since children come when they come."

Patient satisfaction is high, he reports: "I still get phone calls and Christmas cards from some of my patients, and several of them have become pregnant again."

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"This procedure has some real potential and will surely help save some uteruses," says Steven Clark, MD, professor of obstetrics and gynecology at the University of Utah School of Medicine, Salt Lake City.

Clark, who was not involved in the study, tells WebMD that embolization to stop postpartum bleeding is not new. What is new is the use of the balloons, called occlusion. The major drawback is that "it's not usually available in an emergency. But in those cases in which you can predict a high likelihood of bleeding and you have a little more time, I think this would be a good technique."

Razavi and his colleagues have also used embolization to shrink uterine fibroids. Many women have fibroids, benign growths that can cause pain, bleeding, and a feeling of heaviness in the uterus. Hysterectomy is the traditional treatment, but in addition to loss of fertility and the associated psychological impact, the operation can require four to six weeks of recuperation, he says.

To embolize the fibroids, the clinicians feed a catheter through the groin into the blood vessels that supply the fibroids, then inject tiny pellets into the vessels to block the circulation. With no blood to nourish them, the fibroids shrink, and symptoms are relieved.

The complications are significantly fewer than those associated with hysterectomy, and include infection, bruising of the groin area, and a theoretical risk of injecting the pellets into the wrong blood vessel. "All of these complications are benign except for infection," Razavi says. The procedure takes 60 to 90 minutes and requires only light sedation. Side effects include cramps and fatigue for up to a week after the procedure.

Although thousands of gynecologic patients have now undergone uterine fibroid embolization, it still requires some training on the part of the interventional radiologist performing it, as does the procedure to stop hemorrhaging after childbirth. Many community hospitals have no interventional radiologists or other specialists on staff who are skilled in either procedure, say experts speaking at the annual meeting of interventional radiologists in San Diego.

Women should consult their obstetrician-gynecologists or other health care providers to learn about the options in their communities.

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