PREDICTing Post-Embolisation Syndrome after uterine fibroid embolisation: the PREDICT-PES study.

Objectives: To identify the rate of clinically significant post-embolisation syndrome (csPES) in our cohort of patients after uterine artery embolisation for symptomatic fibroids, and to identify risk factors associated with the development of csPES.

Methods: Retrospective case-control study. All patients that underwent uterine artery embolisation for symptomatic fibroids between the 18-month period of 1 March 2022 and 1 September 2023 were recruited. csPES was defined as maximum pain score on visual analogue scale of > 5 out of 10, plus at least one of: morphine patient-controlled analgesia dose >10mg, fever, or use of 2 or more antiemetics.

Results: 69 patients were included, mean age 46.2 years, and median uterine volume 393 mL (range 80-2288 mL). The rate of csPES was 47.8% (33 patients). After adjusting for confounding using multiparametric logistic regression, a positive association was seen between nulliparity and developing csPES (OR 5.51, 95%CI 1.297-23.410, p = 0.021). In addition, a trend was shown between increasing age and a reduced odds of developing csPES (OR 0.87, 95%CI 0.748-1.002, p = 0.054).

Conclusion: The rate of csPES in our cohort was 47.8%, and nulliparity was strongly associated with the development of csPES. We can use this to better counsel our patients regarding the odds of csPES when these risks are present at pre-procedure consultation, and target additional interventions at reducing csPES in this population.

Advances in knowledge: Clinically significant post-embolisation syndrome is common after uterine artery embolisation for symptomatic fibroids. This study showed that nulliparity is a risk factor for developing, previously not known or reported.