Design: This is a video demonstration of a small case series.

Setting: Clinical and operating room settings of a tertiary academic center are described in the video.

Patients or Participants: Three patients are described who had varying presentations of suspected endometritis following T-RFA. Each patient was treated successfully with good outcomes.

Interventions: We describe three cases of T-RFA treatment for symptomatic fibroids. We then review the postoperative sequelae of these three patients, and the successful diagnosis and treatment of postoperative endometritis.

Measurements and Main Results: Each patient underwent T-RFA without intraoperative complications. Postoperative imaging was negative for pelvic abscess or thermal injury. Endometritis was suspected based on symptoms of persistent pelvic pain or fever. One patient had positive blood cultures for Streptococcus agalactiae. The patients were treated with either PO or IV antibiotics with resolution of their symptoms.

Conclusion: The purpose of this video is to highlight three cases with different fibroid burden and clinical courses, but all of whom experienced pain, malaise, leukocytosis, or fever following T-RFA. All of the patients were evaluated and managed by the surgical team, and there were no serious complications. At present, there is limited data to support preventive measures, such as antibiotic prophylaxis for this procedure. Standard surgical vaginal prep is always performed, but it may be reasonable to add prophylactic antibiotics to reduce infection. Also, it is important to have a high index of suspicion for infection for patients presenting with prolonged pain or other symptoms. Expedited workup and treatment is imperative. Additional research to further explore the incidence of pelvic infection following T-RFA will improve the understanding of this procedure.