RCOG World Congress 2023

Investigating Abnormal Uterine Bleeding after Endometrial Ablation; the Management Dilemma.

Reham Marie, MRCOG. Mamta Pathak, FRCOG. Prabath Suraweera, FRCOG.

Worcestershire Royal Hospital NHS Trust, United Kingdom

Objectives

•To review the outcome of hysteroscopy and subsequent management in a cohort of women with abnormal uterine bleeding (AUB) who had undergone endometrial ablation in the past.

Study Design

• A retrospective cohort study.

Methods

•Retrospective case note analysis of subset of women with abnormal uterine bleeding and a history of endometrial ablation who attended outpatient hysteroscopy (OPH) at a large District General Hospital in the United Kingdom from 01-08-2020 to 31-12-2022

•Sample size : n=41.

•

• To minimise the sample heterogeneity, only the cases where the operator was consultant in ambulatory gynaecology care were included.

Discussion

•Endometrial assessment was compromised after previous endometrial ablation. Incidence of failed outpatient hysteroscopy was 94.5 %.

•Endometrial sampling biopsy could be collected in 27% of cases, and was insufficient in 70% of biopsies.

•Further assessment was required in 27 patients (72.9%). Out of these 27 patients,9 underwent hysteroscopy under general anaesthetic, satisfactory views in only one case, and 2 cases had uterine perforation(22%); endometrial biopsy could be collected and yield inadequate in 7 patients

Conclusion

• Uterine cavity assessment after endometrial ablation represents a challenge to ambulatory gynaecology care practitioners.

Currently there is wide discrepancy in practice as there is no clear pathway to follow.

This challenge warrants urgent attention on development of consensus guideline on this domain by national/international learned societies.

RCOG World Congress 2023

Investigating Abnormal Uterine Bleeding after Endometrial Ablation; the Management Dilemma.

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