Checklist for Endometrial Ablation

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This checklist is part of the Gynsurgery guidelines used in an educational setting for residents in Ob-Gyn.

The pdf form of the Checklist for Endometrial Ablation may not contain the latest changes below.

Preoperative assessment

  1. ___ Indicate most likely goal is to normalize menstrual flow (prevent unrealistic expectations)
  2. ___ Assess degree of menstrual bleeding associated pain preoperatively (prevent persistent uterine pain after procedure)
  3. ___ If previous tubal ligation convey increased chance of persistent uterine pain after procedure (prevent unrealistic expectations)
  4. ___ Schedule/perform procedure in proliferative phase of cycle (prevent Postoperative hematometra, prevent failure of procedure, prevent interruption of an intrauterine pregnancy)
  5. ___ Test preoperatively within 48 hours of surgery for pregnancy in any reproductive age woman (prevent interruption of an intrauterine pregnancy)
  6. ___ Suppress endometrial thickness preoperatively with LHRF agonists, progestins, OCPs or by concurrent suction currettage (prevent postoperative hematometra, prevent failure of procedure)
  7. ___ Assess that uterine size does not exceed device maximum (10-14cm) (prevent postoperative hematometra, prevent failure of procedure)
  8. ___ Culture for G.C. and Chlamydia if any discolored cervical mucous (prevent PID, endometritis)
  9. ___ Culture urine if any symptoms of urinary frequency, urgency, dysuria or nocturia (prevent UTI)


  1. ___ At exam under anesthesia, determine version and flexion position of the uterus (prevent uterine perforation, bladder or bowel injury)
  2. ___ Check weighted specula and other instruments for excessive heat (prevent thermal injury problems)___ Put downward traction on cervical tenaculum to straighten out cervical-uterine axis (prevent uterine perforation, bladder or bowel injury)___ Use graduated dilatators to dilate cervix to internal uterine os to size of hysteroscope or intrauterine instrument to be used (prevent cervical laceration)
  3. ___ Avoid excess downward traction on cervical tenaculum (prevent cervical laceration)
  4. ___ Avoid excessive cephalad pressure with cervical dilator (prevent uterine perforation, bladder or bowel injury)
  5. ___ Avoid contaminating intrauterine instruments with vaginal blood and secretions (prevent infection)
  6. ___ Introduce instruments into the uterus in the midline sagittal plane (prevent excessive bleeding)
  7. ___ Follow instrument specific instructions precisely (prevent ablation technique specific malfunction problems)
  8. ___ If resectoscope technique, keep track of distension fluid used and returned; discrepancy to be less than 250ml (prevent hyponatremic fluid overload)
  9. ___ If resectoscope technique, maintain intrauterine pressure at or below the patient’s mean arterial pressure (prevent hyponatremic fluid overload)
  10. ___ If resectoscope technique, try to keep procedure less than 45 minutes (prevent hyponatremic fluid overload)
  11. ___ If resectoscope technique, avoid preoperative overhydration (prevent hyponatremic fluid overload)
  12. ___ If instrument penetration is suspicious for or strongly indicates uterine perforation, discontinue procedure (prevent, bladder, bowel or omental injury or bleeding)

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