Endometrial Ablation - Indications and Complications

Indications

 * 1) Postmenopausal and negative endometrial sampling and hysteroscopy but persistent bleeding and failed HRT or HRT contraindicated
 * 2) Premenopausal with negative endometrial sampling and treated for abnormal bleeding hormonally for >3 months and no resolution of abnormal bleeding (normal thyroid, coagulation studies)

Contraindications

 * 1) Current or planned pregnancy
 * 2) Known or possible endometrial hyperplasia or carcinoma
 * 3) Active genital or urinary tract infection at time of procedure
 * 4) Active pelvic inflammatory disease
 * 5) Intrauterine device concurrently in place

Complications (<4.0%)

 * 1) Cervical laceration
 * 2) Use graduated dilatators to dilate cervix to internal uterine os to size of hysteroscope or intrauterine instrument to be used
 * 3) Avoid excess downward traction on cervical tenaculum
 * 4) Uterine perforation
 * 5) At exam under anesthesia, determine version and flexion position of the uterus
 * 6) Put downward traction on cervical tenaculum to straighten out cervical-uterine axis
 * 7) Avoid excessive cephalad pressure with dilator
 * 8) Excessive Bleeding
 * 9) Introduce instruments into the uterus in the midline sagittal plane
 * 10) Fluid distension media problems glycine solution (hyponatremic fluid overload)
 * 11) Keep track of distension fluid used and returned; discrepancy to be less than 250ml
 * 12) Maintain intrauterine pressure at or below the patient’s mean arterial pressure
 * 13) Try to keep procedure less than 45 minutes
 * 14) Infection
 * 15) Preoperatively, culture for G.C. and Chlamydia if any discolored cervical mucous
 * 16) Avoid contaminating intrauterine instruments with vaginal blood and secretions
 * 17) Thermal energy problems
 * 18) Check weighted specula and other instruments for excessive heat
 * 19) Use instruments for ablation according to manufacturers’ instructions
 * 20) Interruption of an intrauterine pregnancy
 * 21) Test preoperatively within 48 hours of surgery for pregnancy in any reproductive age woman
 * 22) Avoid procedures in the luteal phase of menses in women without sterilization or using effective contraception
 * 23) Bladder, bowel or omental injury
 * 24) Avoid uterine perforation
 * 25) If instrument penetration is suspicious for or strongly indicates uterine perforation, discontinue procedure