Objective: NovaSure endometrial ablation procedure (NEAP) is a one-time, customised treatment for women who suffer with abnormal uterine bleeding (AUB), which uses radiofrequency impedance-based technology. Currently, there are no published guidelines about prophylactic antibiotic therapy for NEAP or other hysteroscopic procedures.

Design: We performed a retrospective audit of 99 cases from January 2010 to March 2014 undergoing NEAP for the management of AUB. In three cases we were not able to proceed with NEAP due to technical issues and one case was lost to follow up. All cases were followed up for 6 months after the procedure.

Results: Prophylactic antibiotics were given to 77 cases (81%) and 18 did not receive antibiotics (19%). Of the ninety-five patients, 4 cases developed endometritis, which were treated with oral antibiotics in three of the cases and one was admitted as an inpatient for intravenous antibiotic therapy. This gives an overall infection (endometritis) rate of 4.2%.

We found that all 4 patients who developed post-op infection were those who received antibiotics i.e. four out of seventy-seven (5.2%) and none of those who had NEAP without prophylactic antibiotics developed post-op infection. Review of case notes revealed post-op antibiotics were given to 58 patients upon discharge from day surgery and 37 did not receive any antibiotics. Of the 4 cases of endometritis, only one was in the post-op antibiotic group and the other three were not given any antibiotics.

At six months follow up, fifty-two cases reported amenorrhoea and thirty-four cases reported either light or very light periods. This gives an amenorrhoea rate of 54% at six months for this unit.

Eighty-six patients out of 95 evaluated the results of NEAP satisfactory (90.5%).

Conclusion: The evidence for prophylactic antibiotic therapy for NEAP is lacking. American Congress of obstetricians and gynecologists and RANZCOG both point out in their practice bulletin and statement, respectively that there is no clear evidence to recommend prophylactic antibiotic therapy for hysteroscopic procedures.

Our retrospective review of case notes casts further doubt on the usefulness of prophylactic antibiotic therapy. However, lack of blinding and historic examination of the data makes our review subject to obvious bias that exists with retrospective reviews. Ideally, a double-blind randomised-controlled trial should provide higher level of evidence regarding the above debate.