Radiofrequency endometrial ablation in patients with a history of low transverse cesarean delivery

Study objective: To assess adverse events associated with radiofrequency endometrial ablation in treatment of heavy menstrual bleeding in patients with a history of low transverse cesarean delivery (C-section group) and patients who delivered vaginally (vaginal delivery group).

Design: Retrospective cohort study (Canadian Task Force classification II-2).

Setting: Community-based gynecology practice in the United States.

Patients: The study included 194 patients (100 in the C-section group and 94 in the vaginal delivery group), aged 21 to 55 years, with a history of heavy menstrual bleeding.

Interventions: NovaSure endometrial ablation procedures were performed from April 2004 through December 2010.

Measurements and main results: Demographic characteristics, gynecologic and pregnancy history, and procedure setting were compared between groups. Intraoperative and postoperative adverse events that occurred within 72 hours of the procedure were summarized. The C-section and vaginal delivery groups were similar for demographic characteristics with the exception of age (mean [SD], 40.6 [5.0] years vs 42.5 [5.3] years, respectively; p = .01). Parity was significantly higher in the C-section group compared with the vaginal delivery group (2.4 [0.9] vs 2.1 [0.7]; p = .006). Adverse events commonly associated with endometrial ablation occurred in 3 patients in the C-section group and 5 patients in the vaginal delivery group (p = .68). In addition, 1 patient failed the pre-ablation cavity integrity assessment; therefore, ablation was not performed. All events resolved without sequelae. No uterine perforation or bowel or bladder injury occurred in any patient.

Conclusion: Radiofrequency endometrial ablation performed in a community practice was well tolerated in patients with a history of low transverse cesarean delivery.