Full-term vaginal live birth after laparoscopic radiofrequency ablation of a large, symptomatic intramural fibroid: A case report

BACKGROUND: This case study describes the first reported vaginal delivery following radiofrequency ablation (RFA) of fibroids. The subject was among a cohort of women seeking treatment for symptomatic fibroids. She was enrolled in a clinical trial studying outcomes of laparoscopic, ultrasoundguided RFA of symptomatic fibroids. Case: A 38-year-old, G4P3, female was diagnosed with uterine fibroids following a spontaneous abortion and preterm delivery at 21 weeks of a nonviable infant. RFA was performed on 7 fibroids, the largest of which was measured by magnetic resonance imaging (MRI) to be a 6.1-cm, submucosal-intramural, right posterior leiomyoma. The patient conceived approximately 3.5 months after RFA. She had a spontaneous labor at term with an uncomplicated vaginal delivery of a 3,487-g female infant (Apgars: 9, 9). Post-RFA and post-delivery MRI images indicated a myometrial thickness of 9.6 mm throughout, including beneath the ablation site. Conclusion: The lack of a uterine defect following RFA in this case may have allowed this patient to progress to term without uterine rupture as has been reported with conventional myomectomy. The use of RFA in infertile women needs further study, and the decision to perform a cesarean section in women who have had RFA needs to be evaluated. The potential to treat many fibroid patients without requirement for subsequent cesarean section also needs further study.