Ten-year follow-up of a randomised controlled trial comparing bipolar endometrial ablation with balloon ablation for heavy menstrual bleeding.

OBJECTIVE: Previously, we have reported that, at both 12months and 5 years after treatment, bipolar endometrial ablation is superior to balloon ablation in the treatment of heavy menstrual bleeding. In this article, we evaluate the results at 10 years after these interventions. DESIGN: Ten-year follow-up of a double-blind randomised controlled trial. SETTING: A teaching hospital in the Netherlands. POPULATION: Premenopausal women suffering from heavy menstrual bleeding. METHOD: A follow-up questionnaire was sent to women 10 years after randomisation for bipolar ablation and balloon ablation (2: 1 ratio). MAIN OUTCOME MEASURES: Amenorrhoea rates, re-intervention and patient satisfaction. RESULTS: At 10 years of follow-up, the response rate was 69/83 (83%) in the bipolar group and 35/43 (81%) in the balloon group. Amenorrhoea rates were 50/69 (73%) in the bipolar group and 23/35 (66%) in the balloon group [relative risk, 1.1 (95% CI, 0.83-1.5)]. Further treatment following initial ablation was reported in 21 cases, 14 in the bipolar group and nine in the balloon group [relative risk, 0.9 (95% CI, 0.63-1.3)]. Eight of these women required further treatment after 5 years, including two hysterectomies. Patient satisfaction in the bipolar group was 81% (56/69) compared with 77% (27/35) in the balloon group [relative risk, 1.1 (95% CI, 0.82-1.2)]. CONCLUSION: Ten years after treatment, the superiority of bipolar ablation over balloon ablation in the treatment of heavy menstrual bleeding was no longer evident.

Arterial balloon occlusion of the internal iliac arteries for treatment of life-threatening massive postpartum haemorrhage: a series of 15 consecutive cases.

OBJECTIVE: To evaluate arterial balloon occlusion of the internal iliac arteries for treatment of life-threatening massive postpartum haemorrhage. STUDY DESIGN: Retrospective cohort study at a tertiary referral perinatal centre in a teaching hospital in the Netherlands. All patients who delivered in our hospital between January 1998 and January 2008 were included in the study. A retrospective analysis of all cases of postpartum haemorrhage was performed. All 15 consecutive cases of massive postpartum haemorrhage were selected from an electronic database. The patients with massive postpartum haemorrhage (blood loss>5000 ml) and the patients with postpartum haemorrhage treated with arterial balloon occlusion of internal iliac arteries were analyzed. RESULTS: In the study period 1246 (7%) of all 17,308 deliveries were complicated by postpartum haemorrhage. 15 (0.1%) patients suffered from massive postpartum haemorrhage. They were all treated with balloon occlusion of the internal iliac arteries. Hysterectomy was performed in 4 patients. All patients survived without any complications. CONCLUSION: Arterial balloon occlusion of the internal iliac arteries is a safe and in most cases effective procedure for treatment of massive life-threatening postpartum haemorrhage.