{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:01:01Z","timestamp":1791414061456,"version":"4.3.3"},"reference-count":63,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T00:00:00Z","timestamp":1677715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Novel treatment options for uterine fibroids, such as uterine artery embolization (UAE), ultrasound-guided and magnetic resonance-guided high-intensity focused ultrasound (USgHIFU and MRgHIFU), and transcervical radiofrequency ablation (TFA) methods, are widely used in clinical practice. This systematic review and meta-analysis (CRD42022297312) aims to assess and compare reproductive and obstetric outcomes in women who underwent these minimally invasive approaches for uterine fibroids. The search was performed in PubMed, Google Scholar, ScienceDirect, Cochrane Library, Scopus, Web of Science and Embase. Risk of bias was assessed using the Newcastle\u2013Ottawa Scale (NOS) and Cochrane guidelines. The articles were selected to meet the following eligibility criteria: (1) research article, (2) human subject research, and (3) the study of pregnancy outcomes after the treatment of uterine fibroids by either one of three methods\u2014UAE, HIFU, and TFA. The analysis of 25 eligible original articles shows a similar rate of live births for UAE, USgHIFU, MRgHIFU, and TFA (70.8%, 73.5%, 70%, and 75%, respectively). The number of pregnancies varied considerably among these studies, as well as the mean age of pregnant women. However, the results of pregnancy outcomes for TFA are insufficient to draw firm conclusions, since only 24 women became pregnant in these studies, resulting in three live births. The miscarriage rate was highest in the UAE group (19.2%). USgHIFU was associated with a higher rate of placental abnormalities compared to UAE (2.8% vs. 1.6%). The pooled estimate of pregnancies was 17.31% to 44.52% after UAE, 18.69% to 78.53% after HIFU, and 2.09% to 7.63% after TFA. The available evidence confirmed that these minimally invasive uterine-sparing treatment options for uterine fibroids are a good approach for patients wishing to preserve their fertility, with comparable reproductive and obstetric outcomes among the different techniques.<\/jats:p>","DOI":"10.3390\/ijerph20054480","type":"journal-article","created":{"date-parts":[[2023,3,3]],"date-time":"2023-03-03T02:03:08Z","timestamp":1677808988000},"page":"4480","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"20","author":[{"given":"Ayazhan","family":"Akhatova","sequence":"first","affiliation":[{"name":"School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5\/1, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2868-4497","authenticated-orcid":false,"given":"Gulzhanat","family":"Aimagambetova","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5\/1, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gauri","family":"Bapayeva","sequence":"additional","affiliation":[{"name":"Clinical Academic Department of Women\u2019s Health, CF \u201cUniversity Medical Center\u201d, Turan Ave. 32, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1543-2802","authenticated-orcid":false,"given":"Antonio Simone","family":"Lagan\u00e0","sequence":"additional","affiliation":[{"name":"Unit of Gynecologic Oncology, ARNAS \u201cCivico\u2013Di Cristina\u2013Benfratelli\u201d, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"Chiantera","sequence":"additional","affiliation":[{"name":"Unit of Gynecologic Oncology, ARNAS \u201cCivico\u2013Di Cristina\u2013Benfratelli\u201d, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3852-5948","authenticated-orcid":false,"given":"Peter","family":"Oppelt","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Gynecologic Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5734-7468","authenticated-orcid":false,"given":"Antonio","family":"Sarria-Santamera","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5\/1, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3914-5154","authenticated-orcid":false,"given":"Milan","family":"Terzic","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5\/1, Astana 010000, Kazakhstan"},{"name":"Clinical Academic Department of Women\u2019s Health, CF \u201cUniversity Medical Center\u201d, Turan Ave. 32, Astana 010000, Kazakhstan"},{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1055\/s-0037-1599090","article-title":"Recent Advances in Uterine Fibroid Etiology","volume":"35","author":"McWilliams","year":"2017","journal-title":"Semin. Reprod. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.bpobgyn.2017.09.004","article-title":"Epidemiology and Risk Factors of Uterine Fibroids","volume":"46","author":"Pavone","year":"2018","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1111\/1471-0528.14640","article-title":"Epidemiology of uterine fibroids: A systematic review","volume":"124","author":"Stewart","year":"2017","journal-title":"BJOG"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1097\/01.grf.0000159538.27221.8c","article-title":"Role, epidemiology, and natural history of benign uterine mass lesions","volume":"48","author":"Ryan","year":"2005","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1055\/s-0037-1607264","article-title":"Uterine Fibroids: Burden and Unmet Medical Need","volume":"35","author":"Myers","year":"2017","journal-title":"Semin. Reprod. Med."},{"key":"ref_6","first-page":"41","article-title":"Uterine fibroids\u2014Clinical presentation and complications","volume":"51","author":"Sparic","year":"2015","journal-title":"ACI"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/s00404-017-4515-5","article-title":"Epigenetic and genetic landscape of uterine leiomyomas: A current view over a common gynecological disease","volume":"296","author":"Vergara","year":"2017","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Yerezhepbayeva, M., Terzic, M., Aimagambetova, A., and Crape, B. (2022). Comparison of two invasive non-surgical treatment options for uterine myomas: Uterine artery embolization and magnetic resonance guided high intensity focused ultrasound\u2014Systematic review. BMC Women\u2019s Health, 22.","DOI":"10.1186\/s12905-022-01627-y"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1111\/jog.14343","article-title":"Uterine fibroids and preterm birth risk: A systematic review and meta-analysis","volume":"46","author":"Ornat","year":"2020","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1007\/s43032-021-00656-6","article-title":"Uterine Fibroids and Pregnancy: How Do They Affect Each Other?","volume":"29","author":"Coutinho","year":"2021","journal-title":"Reprod. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.jmig.2018.06.020","article-title":"Management of Asymptomatic Submucous Myomas in Women of Reproductive Age: A Consensus Statement from the Global Congress on Hysteroscopy Scientific Committee","volume":"26","author":"Tinelli","year":"2019","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.bpobgyn.2015.12.001","article-title":"Infertility and uterine fibroids","volume":"34","author":"Zepiridis","year":"2016","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.ejogrb.2020.11.048","article-title":"Office hysteroscopic myomectomy without myoma extraction: A multicenter prospective study","volume":"256","author":"Tanvir","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"193","DOI":"10.2298\/SARH0804193T","article-title":"Focused ultrasound for treatment of uterine myoma: From experimental model to clinical practice","volume":"136","author":"Terzic","year":"2008","journal-title":"Srp. Arh. Celok. Lek."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1055\/s-0032-1328724","article-title":"Vaginal Removal of Very Large Nascent Uterine Myoma\u2014Case Report and Literature Review","volume":"73","author":"Terzic","year":"2013","journal-title":"Geburtsh. Frauenheilk."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.ejogrb.2017.07.015","article-title":"Vaginal and Laparoscopic hysterectomy as an outpatient procedure: A systematic review","volume":"216","author":"Dedden","year":"2017","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.rbmo.2020.01.003","article-title":"Systematic Review of Pregnancy Outcomes after Fertility-Preserving Treatment of Uterine Fibroids","volume":"40","author":"Khaw","year":"2020","journal-title":"Reprod. BioMed. Online"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.bpobgyn.2015.11.017","article-title":"Pregnancy outcome and uterine fibroids","volume":"34","author":"Parazzini","year":"2016","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1159\/000522583","article-title":"Prevalence of Intrauterine Adhesions after Myomectomy: A Prospective Multicenter Observational Study","volume":"87","author":"Garzon","year":"2022","journal-title":"Gynecol. Obstet. Invest."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"319.e1","DOI":"10.1016\/j.ajog.2013.07.017","article-title":"The impact of uterine leiomyomas: A national survey of affected women","volume":"209","author":"Borah","year":"2013","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1089\/gyn.2019.0012","article-title":"Transcervical Radiofrequency Ablation of Symptomatic Uterine Fibroids: 2-Year Results of the SONATA Pivotal Trial","volume":"35","author":"Miller","year":"2019","journal-title":"J. Gynecol. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1016\/j.jmig.2021.04.009","article-title":"A Systematic Review of the Treatment of Uterine Myomas Using Transcervical Ultrasound-Guided Radiofrequency Ablation with the Sonata System","volume":"28","author":"Arnreiter","year":"2021","journal-title":"J. Minim. Invasive. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00404-022-06516-1","article-title":"The significance of transcervical ultrasound-guided radiofrequency ablation in the treatment of symptomatic fibroids: Results of an expert consensus from German-speaking countries","volume":"306","author":"Bends","year":"2022","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"165","DOI":"10.4103\/GMIT.GMIT_50_19","article-title":"Evaluation of Uterine Artery Embolization on Myoma Shrinkage: Results from a Large Cohort Analysis","volume":"8","author":"Ukybassova","year":"2019","journal-title":"Gynecol. Minim. Invasive. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.ogrm.2020.02.001","article-title":"Modern Management of Fibroids","volume":"30","author":"Baumgarten","year":"2020","journal-title":"Obstet. Gynaecol. Reprod. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2850","DOI":"10.1007\/s00330-016-4681-z","article-title":"Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors","volume":"27","author":"Torre","year":"2017","journal-title":"Eur. Radiol."},{"key":"ref_27","first-page":"582","article-title":"The effect of high-intensity focused ultrasound guided by magnetic resonance therapy on obstetrical outcomes in patients with uterine fibroids\u2014Experiences from the main Polish center and a review of current data","volume":"36","author":"Filipowska","year":"2019","journal-title":"Int. J. Hyperth."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1080\/02656736.2020.1774081","article-title":"A comparison of the pregnancy outcomes between ultrasound-guided high-intensity focused ultrasound ablation and laparoscopic myomectomy for uterine fibroids: A comparative study","volume":"37","author":"Wu","year":"2020","journal-title":"Int. J. Hyperth."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"22768","DOI":"10.1038\/s41598-021-02217-y","article-title":"Multidisciplinary management to optimize outcome of ultrasound-guided high-intensity focused ultrasound (HIFU) in patients with uterine fibroids","volume":"11","author":"Recker","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1016\/j.tjog.2020.09.013","article-title":"500 Cases of High-intensity Focused Ultrasound (HIFU) Ablated Uterine Fibroids and Adenomyosis","volume":"59","author":"Jeng","year":"2020","journal-title":"Taiwan J. Obstet. Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"77","DOI":"10.2147\/MDER.S301166","article-title":"Transcervical Radiofrequency Ablation of Uterine Fibroids Global Registry (SAGE): Study Protocol and Preliminary Results","volume":"14","author":"Christoffel","year":"2021","journal-title":"Med. Devices"},{"key":"ref_32","first-page":"77","article-title":"Radiofrequency Ablation of Uterine Myomas and Pregnancy Outcomes: An Updated Review of the Literature","volume":"ume 14","author":"Polin","year":"2021","journal-title":"J. Minim. Invasive. Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., and Brennan, S.E. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Med., 18.","DOI":"10.1371\/journal.pmed.1003583"},{"key":"ref_34","unstructured":"Higgins, J., Altman, D., and Sterne, J. (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (Updated March 2011), The Cochrane Collaboration. Available online: www.training.cochrane.org\/handbook."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1111\/1471-0528.14833","article-title":"Defining definitions: A Delphi study to develop a core outcome set for conditions of severe maternal morbidity","volume":"126","author":"Schaap","year":"2019","journal-title":"BJOG"},{"key":"ref_36","unstructured":"Wells, G., Shea, S., O\u2019Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2022, June 29). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses. Available online: https:\/\/www.ohri.ca\/\/programs\/clinical_epidemiology\/oxford.asp."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1093\/humrep\/det459","article-title":"Uterine artery embolization for severe symptomatic fibroids: Effects on fertility and symptoms","volume":"29","author":"Torre","year":"2014","journal-title":"Hum. Reprod."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"39","DOI":"10.3109\/13645706.2012.689768","article-title":"Pregnancy following uterine artery embolization: An update","volume":"22","author":"McLucas","year":"2013","journal-title":"Minim. Invasive. Ther. Allied. Technol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1007\/s00270-012-0388-y","article-title":"Uterine artery embolization versus laparoscopic uterine artery occlusion: The outcomes of a prospective, nonrandomized clinical trial","volume":"35","author":"Mara","year":"2012","journal-title":"Cardiovasc. Intervent. Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"100139","DOI":"10.1016\/j.eurox.2021.100139","article-title":"Uterine artery embolization or myomectomy for women with uterine fibroids: Four-year follow-up of a randomised controlled trial","volume":"13","author":"Daniels","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol. X"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s00404-012-2512-2","article-title":"Pregnancy after uterine artery embolization for the treatment of myomas: A case series","volume":"287","author":"Redecha","year":"2013","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/1471-0528.14742","article-title":"Pregnancy outcomes in patients with uterine fibroids treated with ultrasound-guided high-intensity focused ultrasound","volume":"124","author":"Zou","year":"2017","journal-title":"BJOG"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1080\/02656736.2021.1908633","article-title":"Pregnancy outcomes after ultrasound-guided high-intensity focused ultrasound (USgHIFU) for conservative treatment of uterine fibroids: Experience of a single institution","volume":"38","author":"Isern","year":"2021","journal-title":"Int. J. Hyperth."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.ijgo.2012.01.011","article-title":"Outcome of unintended pregnancy after ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroids","volume":"117","author":"Qin","year":"2012","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1080\/02656736.2018.1510548","article-title":"Vaginal delivery outcomes of pregnancies following ultrasound-guided high-intensity focused ultrasound ablation treatment for uterine fibroids","volume":"35","author":"Liu","year":"2018","journal-title":"Int. J. Hyperth."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"3977","DOI":"10.1038\/s41598-017-04319-y","article-title":"Pregnancy outcomes in nulliparous women after ultrasound ablation of uterine fibroids: A single-central retrospective study","volume":"7","author":"Li","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"764","DOI":"10.3109\/02656736.2015.1063169","article-title":"Magnetic resonance-guided high-intensity focused ultrasound for uterine fibroids: Mid-term outcomes of 36 patients treated with the Sonalleve system","volume":"31","author":"Thiburce","year":"2015","journal-title":"Int. J. Hyperth."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2265","DOI":"10.1016\/j.ejrad.2013.08.045","article-title":"Outcome of uterine artery embolization versus MR-guided high-intensity focused ultrasound treatment for uterine fibroids: Long-term results","volume":"82","author":"Froeling","year":"2013","journal-title":"Eur. J. Radiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s13669-017-0194-2","article-title":"A New Paradigm for Uterine Fibroid Treatment: Transcervical, Intrauterine Sonography-Guided Radiofrequency Ablation of Uterine Fibroids with the Sonata System","volume":"6","author":"Toub","year":"2017","journal-title":"Curr. Obstet. Gynecol. Rep."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S48","DOI":"10.1016\/j.jmig.2020.08.382","article-title":"Three-Year Results of the Sonata Pivotal Trial of Transcervical Fibroid Ablation (TFA) for Symptomatic Uterine Myomata","volume":"27","author":"Lukes","year":"2020","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1089\/gyn.2018.0051","article-title":"Long-Term Clinical Outcomes of Transcervical Radiofrequency Ablation of Uterine Fibroids: The VITALITY Study","volume":"35","year":"2019","journal-title":"J Gynecol. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.ejogrb.2014.03.017","article-title":"Ultrasound-guided transvaginal radiofrequency myolysis for symptomatic uterine myomas","volume":"177","author":"Jiang","year":"2014","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s10397-015-0915-3","article-title":"The FAST-EU trial: 12-month clinical outcomes of women after intrauterine sonography-guided transcervical radiofrequency ablation of uterine fibroids","volume":"13","author":"Bongers","year":"2016","journal-title":"Gynecol. Surg."},{"key":"ref_54","first-page":"e1","article-title":"Clinical investigation of fertility after uterine artery embolization","volume":"225","author":"Kuijper","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2473","DOI":"10.1007\/s00330-019-06641-7","article-title":"The Focused Ultrasound Myoma Outcome Study (FUMOS); a retrospective cohort study on long-term outcomes of MR-HIFU therapy","volume":"30","author":"Verpalen","year":"2020","journal-title":"Eur. Radiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1007\/s00330-014-3538-6","article-title":"MRI predictors of clinical success in MR-guided focused ultrasound (MRgFUS) treatments of uterine fibroids: Results from a single centre","volume":"25","author":"Mindjuk","year":"2015","journal-title":"Eur. Radiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.ejogrb.2013.02.023","article-title":"Magnetic resonance imaging-guided focused ultrasound surgery for symptomatic uterine fibroids: Estimation of treatment efficacy using thermal dose calculations","volume":"169","author":"Yoon","year":"2013","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1007\/s10995-014-1624-7","article-title":"Maternal age and risk of labor and delivery complications","volume":"19","author":"Krauss","year":"2015","journal-title":"Matern Child Health J."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1007\/s00404-014-3367-5","article-title":"Would it be too late? A retrospective case-control analysis to evaluate maternal-fetal outcomes in advanced maternal age","volume":"290","author":"Ciancimino","year":"2014","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e00066","DOI":"10.1016\/j.crwh.2018.e00066","article-title":"Rupture of a myomectomy site in the third trimester of pregnancy after myomectomy, septoplasty and cesarean section: A case report","volume":"19","author":"Cho","year":"2018","journal-title":"Case Rep. Womens Health."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1002\/ijgo.13810","article-title":"Uterine rupture during pregnancy: The URIDA (uterine rupture international data acquisition) study","volume":"157","author":"Tinelli","year":"2022","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1080\/13645706.2020.1837884","article-title":"Uterine rupture in pregnancy after hysteroscopic septum resection: A 20-year retrospective analysis","volume":"31","author":"Jansa","year":"2022","journal-title":"Minim. Invasive. Ther. Allied. Technol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.jmig.2020.11.004","article-title":"Uterine Artery Embolization Compared with High-intensity Focused Ultrasound Ablation for the Treatment of Symptomatic Uterine Myomas: A Systematic Review and Meta-analysis","volume":"28","author":"Liu","year":"2021","journal-title":"J. Minim. Invasive. Gynecol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/5\/4480\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:46:27Z","timestamp":1760121987000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/5\/4480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,2]]},"references-count":63,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["ijerph20054480"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20054480","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,2]]}}}