AAGL 2012: Poor Pregnancy Outcomes Confirm Need Contraceptive Counseling after Endometrial Ablation

The use of NovaSure for endometrial ablation results a variety of poor pregnancy outcomes, according to a study presented by Shannon Smith, MD, at the Global Congress of the American Association of Gynecologic Laparoscopists.

In the study, “Pregnancy Outcomes following NovaSure Endometrial Ablation Procedure,” Smith said pregnancy after radiofrequency endometrial ablation is rare, and results in significant complications, morbidity and adverse outcomes for both the patient and fetus. The study aimed to determine whether contraceptive counseling was provided after ablation, and evaluate the outcomes of pregnancies that occurred following endometrial ablation using NovaSure.

The study included preliminary results for six of 20 patients who became pregnant following a NovaSure ablation procedure. Patents were from multiple centers around the United States.

A survey of physicians indicated that four pregnancies resulted in preterm birth between 27 and 36 weeks. One ended in spontaneous abortion in the first trimester; another was continuing into the third trimester without complications.

At conception, patients were between 26 and 29 years old; none reported using a reliable method of birth control. One patient received contraceptive counseling; three did not. One patient was unsure whether she’d been counseled to use contraception.

When pregnancy continued past the first trimester, a number of complications arose:
• Intrauterine growth restriction (IUGR) requiring cesarean hysterectomy,
• Preterm premature rupture of the membrane, placenta acretia, postpartum pyelonephritis with sepsis.
• Fetal distress/decelerations, terminal bradycardia
• IUGR, non-reassuring fetal heart tracing

Smith said, “These results emphasize the importance of physician counseling on the use of a reliable birth control method for patients undergoing endometrial ablation.”