Current and Future Role of HIFU in Obstetric Gynaecology

Abstract

Obstetric gynaecology, as a field in which diagnostic ultrasound has quickly found its place, especially in screening for birth defects and monitoring pregnancies, is also a speciality in which therapeutic ultrasound is used extensively.

In pelvic gynaecology, HIFU therapy is used more specifically in two types of uterine conditions: fibroids and adenomyosis. In both cases, studies have shown significant efficacy in reducing pain and bleeding associated with the conditions, secondarily (more moderately but still significantly) reducing the volume of the lesions. Impact on fertility has yet to be demonstrated.

In rectosigmoid endometriosis, clinical data indicates good treatment feasibility and significant efficacy on digestive and gynaecologic pain symptoms, as well as on quality of life, with no associated severe complications. Should the efficacy of HIFU in treating endometriosis be confirmed over time, it could revolutionise the management of digestive endometriosis by offering a valid minimally invasive alternative to rectosigmoid surgery.

In senology, where visible scars have a particularly significant psychological impact, several teams have been researching the use of HIFU for the destruction of some types of breast lesions (fibroadenomas and breast tumours).

In obstetrics, HIFU could become a treatment of choice for vascular anomalies such as twin-to-twin transfusion syndrome in twin pregnancies. Promising studies are also available regarding the use of HIFU in the treatment of post-partum placenta accreta.