JOURNAL OF GYNECOLOGY AND REPRODUCTIVE BIOLOGY

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Does Previous Uterine Scar (S) Affect the Outcome of Novasure Endometrial Ablation for the Management of Heavy Menstrual Bleeding: A Retrospective Case- Controlled Study

Shamma Al-Inizi

Consultant Gynaecologist and Obstetrician, South Tyneside & Sunderland NHS Foundation Trust, Harton Lane, South Shields, United Kingdom

CitationCitation COPIED

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.

Copyright: © 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. 

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