Sonographic findings in two cases of complicated pregnancy in women previously treated with endometrial ablation

Complications of Hysteroscopic and Uterine Resectoscopic Surgery

Adverse events associated with hysteroscopic procedures are generally rare, but, with increasing operative complexity, it is now apparent that they are experienced more often. There exists a spectrum of complications that relate to generic components of procedures, such as patient positioning, anesthesia, and analgesia, to a number that are specific to intraluminal endoscopic surgery that largely comprise perforation and injuries to surrounding structures and blood vessels. Whereas a number of endoscopic procedures require the use of distending media, the response of premenopausal women to excessive absorption of nonionic fluids used for hysteroscopy is somewhat unique, and deserves special attention on the part the surgeon. There is also an increasing awareness of uncommon but problematic sequelae related to the use of monopolar radiofrequency uterine resectoscopes that involve thermal injury to the vulva and vagina. Furthermore, the uterus that has previously undergone hysteroscopic surgery may behave in unusual ways, at least in premenopausal women who experience menstruation or who become pregnant. Fortunately, better understanding of the mechanisms involved in these adverse events, as well as the use or development of a number of innovative devices, have collectively provided the opportunity to perform hysteroscopic and resectoscopic surgery in a manner that minimizes risk to the patient.

Induction of abortion following radiofrequency ablation of the endometrium: A case report and search for evidence-based practice

OBJECTIVES Pregnancy following endometrial ablation is a rare event that carries significant risks to the mother. The majority of women elect to terminate such pregnancies. This brings into question which of the available methods should best be employed and what kinds of problems to anticipate. CASE We present a case of a pregnancy following radiofrequency endometrial ablation that was terminated surgically and review the relevant English literature. CONCLUSIONS Medical or surgical abortion can be considered as primary methods of terminating a first trimester intrauterine pregnancy following endometrial ablation. The choice will depend on patient preference but also on the available expertise. Cervical stenosis and/or intrauterine adhesions may limit the effectiveness of these methods. In such cases methotrexate is an alternative option, whereas hysterotomy or hysterectomy should be considered as final options. Counselling patients at the time of endometrial ablation regarding the need for contraception, even after prolonged periods of amenorrhoea is of paramount importance. Laparoscopic or hysteroscopic sterilisation can be offered together with endometrial ablation.