Pregnancy after Novasure® Endometrial Ablation: Two Cases and a Literature Survey

N Mak ,Pijnenborg Jma,Ter Haar Jf ,Christine Willekes ,Herman Moreno ,Bongers My

doi:10.15744/2348-9820.3.303

Abstract

NovaSure® endometrial ablation is a successful therapy for patients with heavy menstrual bleeding who do not want to preserve fertility. However, endometrial ablation is not a contraceptive treatment. We report two cases of pregnancy after NovaSure® endometrial ablation. Case 1 is a pregnancy in a 44-year old woman. An elective abortion was performed at 9 5/7 weeks of gestational age. Case 2 is a pregnancy in a 41-year old woman which was complicated by a placenta increta. She underwent a caesarean section followed by a hysterectomy at 35 1/7 weeks of gestational age. Data on pregnancies after NovaSure® are limited. So far, 26 case reports of pregnancy after NovaSure® could be identified. Data were available for merely 11 cases. Due to the high incidence of potentially life-threatening complications, contraception is essential for all women who undergo NovaSure® endometrial ablation.

Highlights

Endometrial ablation is a successful therapy for patients with heavy menstrual bleeding who do not want to preserve fertility [1]
We report two cases of pregnancy after NovaSure® endometrial ablation
The two cases presented here emphasize the need for contraception after NovaSure®

Summary

Introduction

Endometrial ablation is a successful therapy for patients with heavy menstrual bleeding who do not want to preserve fertility [1]. Second-generation endometrial ablation techniques are more effective compared to first-generation techniques regarding the presence of amenorrhea two years after treatment [3]. NovaSure® is a second-generation endometrial ablation technique which was introduced in 2002. NovaSure® ablates the endometrium by using bipolar radiofrequency [4]. With this technique more women report amenorrhea after treatment compared with other endometrial ablation techniques [5]. Twelve-month amenorrhea rates of patients treated by NovaSure® endometrial ablation ranged between 43 and 56% [6]. These good results are caused by the effectiveness of bipolar radiofrequency at destroying the endometrium. Endometrium is extremely able to regenerate, and focal regeneration of remaining endometrium could make the uterus susceptible for pregnancy [7]

Methods

Findings

Discussion

Conclusion