PPO.59 'Clip it or snip it before you ablate it' beware the pregnancy following endometrial ablation. A Case Report of antenatal uterine rupture with placenta percreta. (9th June 2014)

• Record Type: Journal Article
• Authors: Murray, SR; Williams, A; Love, CDB
• Is Part Of: Archives of disease in childhood. Volume 99:Supplement 1(2014)
• Page Start: A169
• Page End: A169
• Publication Date: 2014-06-09
• Subjects: Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2014-306576.498
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Introduction: Endometrial ablation is a common gynaecological treatment for heavy menstrual bleeding. 1 The NICE guideline recommends that women undergoing ablation must be advised to avoid subsequent pregnancy 2 because of the risks of abnormal placentation. 3 We present a case of placenta percreta with uterine rupture at 21 weeks gestation requiring hysterectomy in a pregnancy following ablation. Case: A 33 year old woman presented in her third pregnancy having had 2 spontaneous vaginal deliveries. She had a Novasure® endometrial ablation one year previously for menorrhagia. She did not use contraception post procedure and was amenorrhoeic. Pregnancy was uncomplicated until 21 weeks when she presented with abdominal pain of unknown cause. On day 5 of admission she collapsed with hypovolaemic shock. In theatre, at laparotomy, there was a haemoperitoneum of 2000 mls. A bleeding uterine rupture was found in the posterior fundus. A hysterotomy was performed to deliver the alive but non-viable fetus. The placenta was densely adherent and a subtotal hysterectomy was performed. Total blood loss was 2500 mls. She made a good recovery. Pathology confirmed uterine rupture with placenta percreta. Conclusion: Pregnancy following endometrial ablation can have disastrous complications. Many centres recommend sterilisation at the time of ablation. References: Hare A, Olah K. Pregnancy following endometrial ablation: a review article. J Obs Gyn 2005;25:108–114 NICE clinical guideline. Heavy Menstrual Bleeding. 2007 Herath R, Singh N, Oligbo N. Antenatal uterine rupture in a pregnancy following microwave endometrial ablation. J Obs Gyn 2010