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Announcements and latest updates

Welcome to the Right Decision Service (RDS) newsletter for August 2024.

  1. Contingency planning for RDS outages

Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.

We would like to invite you to a webinar on 26th September 3-4 pm on national and local contingency planning for future RDS outages.  Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.

I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.

 

2.National  IV fluid prescribing  calculator

This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids  . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery.  It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.

Please do spread the word about this new calculator and get in touch with any questions.

 

  1. New toolkits

The following toolkits are now live;

  1. Updated guidance on current and future Medical Device Regulations

We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.

 

  1. Guide to six stages of RDS toolkit development

We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit.  We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process.  The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the toolkit.

 

  1. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:
  • Thursday 5 September 1-2 pm
  • Wednesday 24 September 4-5 pm
  • Friday 27 September 12-1 pm

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

7 Evaluation projects

Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.

We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.

If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

 

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

Endometrial Ablation (123)

Please report any inaccuracies or issues with this guideline using our online form

Heavy menstrual bleeding (HMB) is an important cause of morbidity affecting 1 in 5 of the population and leads to 21% of gynaecology referrals from general practitioners. Endometrial ablation is an effective treatment for HMB and can be performed under local anaesthesia as an office procedure or under general anaesthesia in theatre.

History

  • Date of LMP
  • Frequency and duration of menses
  • Previous treatments for menorrhagia
  • Previous caesarean sections or uterine surgery
  • Contraception - ablation should not be used as a method of contraception and women must be willing to make appropriate contraceptive provision

Examination

  • Pelvic examination
  • BMI if being considered for ablation under GA

Investigations

  • All women undergoing endometrial ablation should have an endometrial biopsy, ideally in advance of the procedure (well tolerated endometrial biopsy is an indication that ablation is suitable to be carried out under local anaesthetic in a clinic setting rather general anaesthetic in theatre)
  • All women undergoing endometrial ablation should have a pelvic ultrasound prior to the procedure to determine uterine size and morphology and to assess the endometrial cavity. A measurement of any previous LUSCS scar should be made (scar thickness < 8 mm – consider treating only endometrium above level of scar).
  • If there is doubt regarding suitability of the cavity for an ablation, then consideration should be given to performing hysteroscopy to confirm suitability before dating for the procedure.
  • Hysteroscopic assessment of the endometrial cavity must be made prior to the procedure. This should be performed immediately following dilation of the cervix, prior to insertion of the ablation device. This is essential to exclude perforation or creation of a false passage.

Contra-indications to endometrial ablation

  • Woman wishes to retain her fertility
  • Genital tract malignancy
  • Unexplained vaginal bleeding
  • Acute pelvic infection
  • Uterine abnormalities e.g. septate uterus
  • Previous classical caesarean section
  • Other contra-indications will depend on the technique employed e.g. regularity of the uterine cavity, presence and size of fibroids. The surgeon should be familiar with the manufacturer’s guidelines for all products that are used and their limitations.

Ablation technique

This guideline refers only to second generation ablation techniques in use in GG&C. It does not refer to first generation techniques such as TCRE and rollerball ablation. The ablation method used will depend on local expertise and availability of equipment.

Novasure®

This uses impedance controlled bipolar energy to cause ablation using a gold mesh electrode to conform to the contours of the uterine cavity. Depth of ablation is 2-3mm at the cornu and 5-7mm in the main body of the uterus. Treatment time is 90-120 seconds. There is an added safety feature using carbon dioxide to test for uterine perforation before treatment. Safety and efficacy have not been assessed in uterine cavities with a sounded length of greater than 10cm.

Complications of second generation devices

Minor complications are common and include pain and nausea. Serious complications are relatively rare but have been reported e.g. uterine perforation and damage to adjacent structures e.g. bowel. Patients should receive an information leaflet giving instructions about post-operative pain and how to access out-of-hours emergency gynaecology services.

Patients who require readmission following an ablation procedure should be assessed by senior staff to rule out intra-abdominal injury. Where there is any doubt, laparoscopy or laparotomy should be performed.

Antibiotic Prophylaxis

Antibiotic prophylaxis is not required.

Patient information

RCOG. Endometrial ablation (2015)

Appendix: Ablation proforma

Ablation proforma

Editorial Information

Last reviewed: 30/04/2018

Next review date: 30/04/2023

Author(s): Claire Higgins.

Approved By: Gynaecology Clinical Governance Group

Document Id: 123