Purpose: The purpose of this study is to assess the risk of infection after uterine fibroid embolization (UFE) in patients with an intrauterine device (IUD) in place during treatment. The presence of a foreign body within the uterine cavity combined with necrotic endometrial tissue after UFE is speculated to foster pelvic infection. Few studies suggest the risk of pelvic inflammatory disease attributable to IUD is insignificant, however scant evidence exists to assess infectious outcomes in IUD patients in the setting of UFE. Given the growing prevalence of IUD, these findings may help guide peri-procedural management in this subgroup of UFE patients.
Material and Methods: A single institution retrospective analysis of UFE procedures from 2009 to 2019 was performed. Inclusion criteria were cases with imaging evidence of IUD in place at the time of UFE. Demographic, procedural, and clinical data were obtained from review of the medical records. Post-procedural infection was defined as fever in the absence of other illness and/or malodorous vaginal discharge that required treatment with antibiotics within 6 months of the procedure.
Results: A total of 17 patients were included in this study. Of these patients, 5 of 17 (29%) patients developed post-procedure fever and/or malodorous vaginal discharge. Overall, 3 of 17 (18%) patients required antibiotics to treat pelvic infection post-UFE.
Conclusions: The rate of post-UFE pelvic infection in patients with an IUD may be higher than suggested in current literature. While further studies need to be performed either prospectively or with propensity score matching, operators should consider routine peri-procedural antibiotics in this population of patients undergoing UFE.