Biomaterials in Obstetrics and Gynecology - Biomaterials Science: An Integrated Clinical and Engineering Approach - page 159

increases local production of prostaglandins, causing cervical ripening. A
synthetic product with similar hygroscopic ability, Lamicel ® , is commer-
cially available. Apart from its use for induction of labor, Laminaria is used
for cervical dilation prior to dilatation and curettage (D&C) of the uterus for
the treatment of missed abortion or in cases of medical abortion. In fact, it is
widely used in order to reduce complications related to cervical dilation by
its ability to promote controlled cervical ripening [20].
Improving Quality of Life
The use of Biomaterials in the Treatment of
Benign Gynecologic Conditions
Uterine Artery Embolization
Uterine fibroids (leiomyomas, myomas) are the most common tumors of
the female genital tract. According to recent studies, the lifetime risk of
fibroids in a woman over the age of 45 is more than 60%, with incidence
higher in blacks than in whites. Although most fibroids cause no symptoms,
fibroid uterus remains a leading cause of hysterectomy. Fibroid tumors are
regulated by many factors, mainly ovarian steroids, estrogen and proges-
terone, growth factors, and angiogenic factors. Black race, nulliparity, obe-
sity, polycystic ovary syndrome, hypertension, and diabetes are associated
with increased risk of fibroids. The genetic basis of uterine fibroids has not
been elucidated yet; however, recent studies demonstrated the role of key
genes in the pathogenesis of these tumors, including genes related to alcohol
metabolism and apoptosis. Additionally, a few familial syndromes of uterine
fibroids were described, raising the possible role of the gene coding to the
protein fumarate hydratase, a Krebs cycle enzyme.
Until recently, the mainstay of treatment of uterine fibroids was hyster-
ectomy. In the past two decades, minimally invasive techniques have been
utilized to improve symptoms of fibroids without hysterectomy. One of
the most effective uterine-sparing methods is uterine fibroid embolization
(UFE). Embolization is a minimally invasive means of blocking the arteries
that supply blood to the fibroids. In this procedure, a catheter in introduced
into the uterine arteries using angiographic techniques. Then, small parti-
cles of polyvinyl alcohol (PVA) are injected into the arteries, which results
in their blockage. This procedure was first used to reduce blood loss during
resection of fibroids (myomectomy). Surprisingly, patients who were treated
with UFE prior to myomectomy showed reduction in their fibroid size and
improvement of symptoms while awaiting surgery. Recent studies have
shown that UFE is a safe and effective uterine-sparing treatment for uterine
fibroids.