Pregnancy Outcomes after Endometrial Ablation in a Multi-institutional Cohort

Alison M. Bauer; David N. Hackney; Sherif El-Nashar; David Sheyn

doi:10.1055/s-0038-1626710

American Journal of Perinatology, Table of Contents

Am J Perinatol 2018; 35(10): 931-935
DOI: 10.1055/s-0038-1626710

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pregnancy Outcomes after Endometrial Ablation in a Multi-institutional Cohort

Alison M. Bauer

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio

,

David N. Hackney

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio

,

Sherif El-Nashar

²Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio

,

David Sheyn

²Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio

› Author Affiliations

Abstract

Objective The objective of this study was to determine the incidence of morbidly adherent placenta in pregnancies after endometrial ablation.

Study Design We performed a retrospective cohort analysis using a large, multiinstitutional deidentified clinical database, IBM EPM: Explore (IBM Corporation, Somers, NY). We identified women who underwent endometrial ablation and had a subsequent delivery between 1999 and 2016. Patients with a delivery and no prior ablation were used as controls. The association between morbidly adherent placenta, ablation, and other known risk factors for morbidly adherent placenta was analyzed using multivariable logistic regression.

Results Of 162,100 reproductive-aged women who underwent endometrial ablation, 2,770 women (1.71%) subsequently had a delivery. The rate of morbidly adherent placenta was 1 in 13.9 pregnancies after ablation compared with 1 in 838.7 pregnancies in the control group (adjusted odds ratio [aOR], 20.22, p < 0.0001).

Conclusion Pregnancies that occurred after endometrial ablation were associated with increased rates of morbidly adherent placenta.

Keywords

endometrial ablation - placenta accreta - morbidly adherent placenta - pregnancy outcomes

Full Text

References

References
1 Committee on Obstetric Practice. Committee opinion no. 529: placenta accreta. Obstet Gynecol 2012; 120 (01) 207-211
2 ACOG Committee on Practice Bulletins. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 81, May 2007. Obstet Gynecol 2007; 109 (05) 1233-1248
3 Gimpelson RJ. Ten-year literature review of global endometrial ablation with the NovaSure® device. Int J Womens Health 2014; 6: 269-280
4 Sharp HT. Endometrial ablation: postoperative complications. Am J Obstet Gynecol 2012; 207 (04) 242-247
5 Cook JR, Seman EI. Pregnancy following endometrial ablation: case history and literature review. Obstet Gynecol Surv 2003; 58 (08) 551-556
6 Yin CS. Pregnancy after hysteroscopic endometrial ablation without endometrial preparation: a report of five cases and a literature review. Taiwan J Obstet Gynecol 2010; 49 (03) 311-319
7 Lo JS, Pickersgill A. Pregnancy after endometrial ablation: English literature review and case report. J Minim Invasive Gynecol 2006; 13 (02) 88-91
8 Hamar BD, Wolff EF, Kodaman PH, Marcovici I. Premature rupture of membranes, placenta increta, and hysterectomy in a pregnancy following endometrial ablation. J Perinatol 2006; 26 (02) 135-137
9 Lappen JR, Sheyn D, Hackney DN. Does pregnancy increase the risk of abdominal hernia recurrence after prepregnancy surgical repair?. Am J Obstet Gynecol 2016; 215 (03) 390.e1-390.e5
10 Kaelber DC, Foster W, Gilder J, Love TE, Jain AK. Patient characteristics associated with venous thromboembolic events: a cohort study using pooled electronic health record data. J Am Med Inform Assoc 2012; 19 (06) 965-972
11 The IBM Explorys Platform. Available at: https://www-01.ibm.com/common/ssi/cgi-bin/ssialias?htmlfid=HPS03052USEN . Accessed January 24, 2018
12 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. ; STROBE Initiative. The strengthening the reporting of bbservational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370 (9596): 1453-1457