The use of transvaginal ultrasound evaluation premicrowave endometrial ablation

Abstract

Microwave endometrial ablation (MEA) is a popular minimally invasive treatment for menorrhagia compared with hysterectomy. Guidelines from the National Institute for Health and Clinical Excellence (NICE) state that a transvaginal ultrasound scan should be done preoperatively on all prospective MEA patients to avoid complications by assessing the uterus and adjacent structures for abnormalities. The purpose of the study is to correlate the findings of pre-MEA ultrasound scans and outcomes of these patients. A two-year retrospective computed radiology information system (CRIS) search containing ‘Pre MEA’ was identified from 1 January 2007 to 31 December 2008. All scans were reviewed and classified as: (A) normal, (B) relative contraindication to MEA or (C) absolute contraindication to MEA. A total of 52 reports were found in this two-year period. Of these, 22 were normal, 24 were in category B and six in category C. Within category B, 20 had undergone previous lower segment Caesarean sections. One had a thin fundus and three had non-distorting fibroids. The six cases in category C had either distorting fibroids or polyps. The proportion of those who proceeded to MEA was 72% (16/22) within category A, 54% (13/24) in category B and 0% (0/6) in category C. No reported complications in all patients who underwent the procedure. In conclusion, transvaginal ultrasound examination is vital in assessing the uterus and adjacent pathology prior to MEA. The results demonstrate compliance to current NICE guidelines. Ultrasound has the ability to aid gynaecologists in selecting suitable patients for MEA, eliminate potential complications and reduce the rate of unsuccessful procedures.