Research Article
Does Previous Uterine Scar (S) Affect the Outcome of Novasure Endometrial Ablation for the Management of Heavy Menstrual Bleeding: A Retrospective Case- Controlled Study
Author Affiliations
Consultant Gynaecologist and Obstetrician, South Tyneside & Sunderland NHS Foundation Trust, Harton Lane, South Shields, United Kingdom
Corresponding Author
Shamma Al-Inizi, Consultant Gynaecologist and Obstetrician Department of Obstetrics and Gynaecology, South Tyneside Hospital, South Shields, United Kingdom
Citation
Al-Inizi S. Does Previous Uterine Scar (S) Affect the Outcome of Novasure Endometrial Ablation for the Management of Heavy Menstrual Bleeding: A Retrospective Case- Controlled Study. J Gynecol Reprod Biol. 2020 May;1(1):103.
© 2020 Al-Inizi S. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 international License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Objective: To identify if the presence of previous caesarean section (CS) scar (s) can
affect the outcome of women with heavy menstrual bleeding (HMB) undergoing Novasure
endometrial ablation compared to women with unscarred uterus.
Design: A retrospective case review study comparing women with scarred and
unscarred uterus undergoing Novasure endometrial ablation for HMB.
Material and Methods: A retrospective case note review was conducted from
November 2015- December 2019 at South Tyneside Hospital on all women with HMB who
underwent Novasure endometrial ablation. Women with scarred and unscarred uterus
were compared and data collected.
Results: 179 women were included in the study. 33 had previous C/S scar(s), the
majority of whom had one C/S scar. A control group of 145 women with unscarred uterus
was included with comparable demographics. The procedure was completed in 91% of
women with scarred uterus and was abandoned in the rest, whereas it was completed in
97% of women with unscarred uterus. Success rate was 67% in the scarred uterus group
and 33% needed hysterectomy due to continuing heavy periods or pain. In the unscarred
uterus group; 95% had a successful procedure and only 5% needed hysterectomy. One
woman in the scarred uterus group had uterine perforation (procedure abandoned) needing
overnight admission, all the rest of cases were performed as a day procedure. Histology of
removed uterus in both groups found fibroids and adenomyosis.
Conclusions: Novasure endometrial ablation was found to be significantly more
successful in women with unscarred uterus compared to those with previous C/S scars
with higher procedure completion rate, less complications and less need for hysterectomy
for failed procedure. Caution should be taken in selecting patients with fibroids and
adenomyosis as success rate might decline regardless of the presence or absence of a
uterine scar.
Keywords
Endometrial ablation; Heavy menstrual bleeding; Late Onset Endometrial Ablation
Failure; Caesarean section
Introduction
Heavy menstrual bleeding (HMB) is a common gynaecological problem affecting
around 20% of women of reproductive age. It has a major adverse effect on the physical,
mental wellbeing and quality of life of many women [1]. It also contributes considerably to
medical care costs in addition to its significant effect on quality of life and reproductivity of
sufferers [2].
Endometrial ablation (EA); introduced first in the late 19th century; a minimally invasive
gynaecologic tool to control profuse vaginal bleeding avoiding hysterectomy and it has
been widely used in the developed world filling the gap between medical therapy and
hysterectomy.
EA is a safe procedure, requires nominal training and enjoys a substantial rate of success
which has contributed to some extent to a significant reduction in hysterectomy rates in the
United States & the UK between the years 1998 and 2010 [3,4].
According to a recently published Cochrane review, no apparent differences between
1st and 2nd generation methods of EA were found in women with HMB including patient`s
satisfaction, inability to work, quality of life or requirement for further surgery [5].
The impedance bipolar radiofrequency ablation (Novasure) is a second-generation
non-resectoscopic technique which has been used since more than 15 years with over 2.5
million women treated. It is quick and Simple with no pre-treatment
required, performed at any time during the menstrual cycle and can
be learnt easily with less complications and shorter operation time .
It utilises unique patented technology to deliver customised ablation
to each patient [6]. It has a favourable safety profile with patient
satisfaction rate reaching 90% and amenorrhoea rate at 12 months
acceding 55% [7].
Late Onset Endometrial Ablation Failure (LOEAF) has been
previously published to indicate that about a quarter of women who
undergo the procedure will eventually require a hysterectomy while
an unknown number have less than satisfactory results [8]. The
author recommended understanding the etiology and risk factors
that predispose to LOEAF. Different reasons leading to LOEAF were
reported excluding uterine scar (s) as a possible leading cause for
LOEAF [8]. There is only scarce data indicating the influence of having
a scarred uterus on the outcome of EA [9,10]. There are no previous
data comparing the outcome of Novasure ablation in women with
scarred and unscarred uterus, hence this study was conducted.
