Thermal balloon endometrial ablation safe in women with prior cesarean section, reveals study

Women who have experienced one or more cesarean sections can safely undergo thermal balloon endometrial ablation (TBEA) without an increased risk of complications, finds a new study that was published in the recent issue of European Journal of Obstetrics & Gynecology and Reproductive Biology journal. This comprehensive study spanned for five years from November 2017 to December 2022 and provided significant insights into the safety of thermal balloon endometrial ablation for the women with history of cesarean sections.

The retrospective cohort study included a total of 361 women who underwent thermal balloon endometrial ablation at Kepler University Hospital. This research divided the participants into two groups; one group had women with at least one previous cesarean section (29.3%, n = 105) and the other group had women without any history of cesarean sections. The study used Fisher’s exact test to analyze the link between complications and previous cesarean sections.

The findings of this study revealed that the incidence of intraoperative uterine rupture was not significantly associated with a history of cesarean section. Also, no uterine ruptures occurred in the group without prior cesareans, while only one case (1%) was observed in the cesarean section group. This case included a rupture at the uterine fundus due to a previously undetected uterine perforation from an earlier intrauterine device (IUD) insertion.

Further analysis of secondary endpoints, included overall complication rates, postoperative endometritis, vesicouterine fistula and different grades of Clavien-Dindo classifications and showed no significant differences between the two groups. The readmission rate for bleeding disorders was identical at 11.4% in both groups that highlights the lack of increased risk for women with a history of cesarean sections.

The findings of the study supports the conclusion that thermal balloon endometrial ablation is a safe procedure for women who have had one or more prior cesarean sections with transverse isthmocervical hysterotomy. The outcomes of this study suggests that previous cesarean sections should not be a curb for women who consider thermal balloon endometrial ablation for the treatment of heavy menstrual bleeding or other endometrial conditions. Overall, the results of this study are significant by offering reassurance that thermal balloon endometrial ablation can be performed safely following cesarean section.

Reference:

Enzelsberger, S.-H., Oppelt, P., Enengl, S., Palme, I. S., & Trautner, P. S. (2024). Perioperative complications in women undergoing thermal balloon endometrial ablation after one or more cesarean deliveries. In European Journal of Obstetrics & Gynecology and Reproductive Biology (Vol. 299, pp. 18–21). Elsevier BV. https://doi.org/10.1016/j.ejogrb.2024.05.034