RISK INSTRUMENTATION

Risk Instrumentation



Risk Instrumentation

Question 1) A serious incident has occurred following an endometrial ablation on a 43 year old patient with menorrhagia. Read the attached clinical history and chronology of events and write a descriptive report of the case. Emphasise any avoidable factors and make some recommendations that may help prevent a similar incident in the future.

Mrs SB was a 43 year old teacher. The history taken in the clinic was as follows:

Heavy periods for last 3 years

Cycle 7/21-24

Pain with periods ++

Clots 3

Floods 3

Inability to work with periods

Has tried tranexamic acid with GP. No help

Does not want hormones

Routine asepsis. EUA - enlarged uterus - 10/40, minimal uterine decent Cx dilated to H8, sound 10cm. She had not had her bowels opened in the last 24 hours, had no appetite and felt “ hot & cold”. Her observations were: Pulse 98bpm, BP 96/53, temp 37.8o. Mrs SB had a small bowel resection with re-anastomosis and covering loop ileostomy.

Endometrial ablation is performed to reduce menstrual bleeding, such as menorrhagia. Menorrhagia is menstrual bleeding that is heavy in amount or duration and that occurs at regular intervals. Loss of more than 80 mL of blood per menstrual cycle is considered abnormal. Menorrhagia affects approximately 10-30% of premenopausal women and up to 50% of perimenopausal women(DeCherney, 2011: 668-70). Abnormal bleeding is a common reason for outpatient gynecologic visits and is one of the most common causes for surgery among women. In the past, hysterectomy was the most common surgical treatment for menorrhagia; 10% of hysterectomies are performed for menstrual disorders. Although endometrial ablation is not a pure substitute for hysterectomy, it offers patients a fast, outpatient procedure, with little to no postoperative downtime; It also affords a reasonable surgical option for those patients who have failed, declined, or are ineligible for medical therapy, and who also desire to avoid hysterectomy. The etiology of menorrhagia may not always be known, but endometrial hyperplasia or carcinoma must be excluded as the cause of bleeding before proceeding to the endometrial ablation. Since then, global endometrial ablation (GEA) devices, developed to treat all areas of the endometrial cavity simultaneously or with minimal manipulation of the device, have simplified the application of endometrial ablation and extended the location of the procedure to the office setting. These devices require less operator time and training to achieve excellent results(Fritsch, 2010: 1409-18). To date, 5 GEA devices have been approved by the US Food and Drug Administration (FDA) for minimally invasive treatment of idiopathic menorrhagia (see Equipment).

GEA techniques have improved the ease with which gynecologic surgeons can effectively treat abnormal uterine bleeding of benign origin. Improvements in these devices have come quickly, including the ability to treat submucosal fibroids and irregularly shaped endometrial cavities. The high overall success and patient satisfaction rates reported with GEA techniques make them a viable option for conservative surgical management.

Some of the previous contraindications to endometrial ablations, including irregular cavity shape and larger-than-average cavity size, have been addressed by some of the global endometrial ablation ...