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| https://www.invitra.com |
Women
undergoing Endometrial ablation should be informed that pregnancy is possible
after the procedure and is associated with significant maternal and neonatal
morbidity. She should be advised to use contraception after the procedure says
the results of a systematic review published 27 September 2017 in British
Journal of Obstetrics and Gynecology (BJOG).
This is the
first systematic review published on this topic despite years of use of
endometrial ablation for Abnormal Uterine Bleeding (AUB). After a new technology is introduced, it takes
years to come to know about unintended consequences and pregnancy is a late
complication of EA.
This review
by Kohn et al. reports 274 cases of pregnancy after endometrial ablation
in median 1.5 years after the procedure (range 3 weeks – 13 years). The mean
age of women was 37.5 ± 5(range 26-50 years). About 80-90% had not used any form
of contraception, but the remaining does use some form of contraception.
1 in 4
pregnant women were amenorrhoeic after ablation.
About 4 out
of every 5 pregnancies ended into miscarriage, ectopic or termination. Those
who continued either had preterm labor, preterm premature rupture of membranes (PROM),
morbidly adherent placenta, cesarean, cesarean hysterectomy and rupture of
uterus. There was also higher incidence of neonatal complications like IUGR,
prematurity, IUD or early neonatal demise.
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| Methods of doing Endometrial Ablation http://www.cmdrc.com |
It was also
seen that first generations ablation devices were more commonly used in
clinical practice and have higher rates of less completely ablated endometrium,
with lower rates of post-ablation amenorrhea and concomitant higher risk for
subsequent pregnancy.
Physicians
should explain in detail the risk of post-ablation pregnancy, using reliable
contraception even if they are amenorrhoeic or perimenopausal.
In an accompanying
commentary, Sharp HT focuses that physicians should think of alternative ways
to treat AUB like levonorgestrel-containing intrauterine devices or delay
ablation until completion of childbearing. If women still desire pregnancy
after ablation, surrogacy or adoption can be a valid alternative.
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