A 38-year-old woman with symptomatic uterine fibroids (largest 6 cm intramural) declines surgery and requests non-surgical options. She has completed her family. Uterine artery embolization (UAE) is proposed. Which fibroid characteristic is an ABSOLUTE contraindication to UAE?

• A Submucosal fibroid type 1 with > 50% intracavitary component
• B Multiple fibroids with largest > 10 cm in size
• C Fibroid with calcification on imaging
• D Pedunculated subserosal fibroid with narrow stalk diameter < 2 cm ✓

Explanation

Pedunculated subserosal fibroid with a narrow stalk (< 2 cm stalk diameter) is a relative-to-absolute contraindication for UAE because post-embolization necrosis of the fibroid can cause the peduncle to detach, resulting in a free peritoneal body or adhesion formation. This is the main anatomical contraindication. Submucosal fibroids with high intracavitary component are considered by some centers as relative contraindications (risk of expulsion with potential for infection). Large fibroids and calcified fibroids are not absolute contraindications, though response rates may be lower. UAE is generally effective for type 0-2 submucosal fibroids if there is at least 50% intramural component.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.