Checklist for Endometrial Ablation

Preoperative assessment

 * 1) ___ Indicate most likely goal is to normalize menstrual flow (prevent unrealistic expectations)#___ Assess degree of menstrual bleeding associated pain preoperatively (prevent persistent uterine pain after procedure)
 * 2) ___ If previous tubal ligation convey increased chance of pain Persistent uterine pain after procedure (prevent unrealistic expectations)
 * 3) ___ Schedule/perform procedure in proliferative phase of cycle (prevent Postoperative hematometra, prevent failure of procedure, prevent interruption of an intrauterine pregnancy)
 * 4) ___ Test preoperatively within 48 hours of surgery for pregnancy in any reproductive age woman (prevent interruption of an intrauterine pregnancy)
 * 5) ___ Suppress endometrial thickness preoperatively with LHRF agonists, progestins, OCPs or by concurrent suction currettage (prevent Postoperative hematometra, prevent failure of procedure)
 * 6) ___ Assess that uterine size does not exceed device maximum (10-14cm) (prevent Postoperative hematometra, prevent failure of procedure)
 * 7) ___ Culture for G.C. and Chlamydia if any discolored cervical mucous (prevent PID, endometritis)
 * 8) ___ Culture urine if any symptoms of urinary frequency, urgency, dysuria or nocturia (prevent UTI)

Intraoperatively

 * 1) ___ At exam under anesthesia, determine version and flexion position of the uterus (prevent uterine perforation, bladder or bowel injury)
 * 2) ___ Check weighted specula and other instruments for excessive heat (prevent thermal injury problems)___ Put downward traction on cervical tenaculum to straighten out cervical-uterine axis (prevent uterine perforation, bladder or bowel injury)___ Use graduated dilatators to dilate cervix to internal uterine os to size of hysteroscope or intrauterine instrument to be used (prevent cervical laceration)
 * 3) ___ Avoid excess downward traction on cervical tenaculum (prevent cervical laceration)
 * 4) ___ Avoid excessive cephalad pressure with cervical dilator (prevent uterine perforation, bladder or bowel injury)
 * 5) ___ Avoid contaminating intrauterine instruments with vaginal blood and secretions (prevent infection)
 * 6) ___ Introduce instruments into the uterus in the midline sagittal plane (prevent excessive bleeding)
 * 7) ___ Follow instrument specific instructions precisely (prevent ablation technique specific malfunction problems)
 * 8) ___ If resectoscope technique, keep track of distension fluid used and returned; discrepancy to be less than 250ml (prevent hyponatremic fluid overload)
 * 9) ___ If resectoscope technique, maintain intrauterine pressure at or below the patient’s mean arterial pressure (prevent hyponatremic fluid overload)
 * 10) ___ If resectoscope technique, try to keep procedure less than 45 minutes (prevent hyponatremic fluid overload)
 * 11) ___ If resectoscope technique, avoid preoperative overhydration (prevent hyponatremic fluid overload)
 * 12) ___ If instrument penetration is suspicious for or strongly indicates uterine perforation, discontinue procedure (prevent, bladder, bowel or omental injury or bleeding)