Placenta Percreta and Incomplete Uterine Rupture after Endometrial Ablation and Tubal Occlusion

 

 Permissions and Reprints

Abstract

Endometrial ablation offers symptomatic relief for menorrhagia. Pregnancy after ablation is rare but is often complicated due to pregnancy loss, growth restriction, preterm premature rupture of membranes, preterm delivery, and morbidly adherent placentation, a dangerous complication that can result in hemorrhage, intensive care unit admission, and cesarean hysterectomy. We report a case of pregnancy conceived contemporaneously with endometrial ablation and tubal occlusion. Diagnosis of pregnancy was delayed due to low suspicion. Complications included cervical implantation and placenta percreta, necessitating hysterectomy with the fetus in situ. Intraoperatively, incomplete uterine rupture was noted. Abnormal neovascularization, fibrous adhesions, and anatomical distortion necessitated a complex surgical approach. Women undergoing endometrial ablation must be thoroughly counseled about the serious risks of postablation pregnancy, the need for contraception, and the risk of sterilization failure. Pregnancy should remain in the differential diagnosis for women of reproductive age, regardless of tubal occlusion. Cases of placenta percreta should be referred early to centers of excellence with multidisciplinary teams.

• References

• 1 Vahanian SA, Lavery JA, Ananth CV, Vintzileos A. Placental implantation abnormalities and risk of preterm delivery: a systematic review and metaanalysis. Am J Obstet Gynecol 2015; 213 (4, Suppl): S78-S90
  CrossrefPubMedGoogle Scholar
• 2 Eshkoli T, Weintraub AY, Sergienko R, Sheiner E. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Am J Obstet Gynecol 2013; 208 (3) 219.e1-219.e7
  CrossrefPubMedGoogle Scholar
• 3 Belfort MA ; Publications Committee, Society for Maternal-Fetal Medicine. Placenta accreta. Am J Obstet Gynecol 2010; 203 (5) 430-439
  CrossrefPubMedGoogle Scholar
• 4 Shawki O, Wahba A, Magon N. Abnormal uterine bleeding in midlife: the role of levonorgestrel intrauterine system. J Midlife Health 2013; 4 (1) 36-39
  PubMedGoogle Scholar
• 5 Committee on Practice Bulletins—Gynecology. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol 2012; 120 (1) 197-206
  CrossrefPubMedGoogle Scholar
• 6 Miller JD, Lenhart GM, Bonafede MM, Basinski CM, Lukes AS, Troeger KA. Cost effectiveness of endometrial ablation with the NovaSure(®) system versus other global ablation modalities and hysterectomy for treatment of abnormal uterine bleeding: US commercial and Medicaid payer perspectives. Int J Womens Health 2015; 7: 59-73
  PubMedGoogle Scholar
• 7 Pugh CP, Crane JM, Hogan TG. Successful intrauterine pregnancy after endometrial ablation. J Am Assoc Gynecol Laparosc 2000; 7 (3) 391-394
  CrossrefPubMedGoogle Scholar
• 8 Xia E, Li TC, Yu D , et al. The occurrence and outcome of 39 pregnancies after 1621 cases of transcervical resection of endometrium. Hum Reprod 2006; 21 (12) 3282-3286
  CrossrefPubMedGoogle Scholar
• 9 Gervaise A, de Tayrac R, Fernandez H. Contraceptive information after endometrial ablation. Fertil Steril 2005; 84 (6) 1746-1747
  CrossrefPubMedGoogle Scholar
• 10 Daniels JP. The long-term outcomes of endometrial ablation in the treatment of heavy menstrual bleeding. Curr Opin Obstet Gynecol 2013; 25 (4) 320-326
  CrossrefPubMedGoogle Scholar
• 11 Yin CS. Pregnancy after hysteroscopic endometrial ablation without endometrial preparation: a report of five cases and a literature review. Taiwan J Obstet Gynecol 2010; 49 (3) 311-319
  CrossrefPubMedGoogle Scholar
• 12 Patni S, ElGarib AM, Majd HS, Edwards GJ, Ashraf MA. Endometrial resection mandates reliable contraception thereafter - a case report of placenta increta following endometrial ablation. Eur J Contracept Reprod Health Care 2008; 13 (2) 208-211
  CrossrefPubMedGoogle Scholar
• 13 Fox K, Shamshirsaz A, Belfort M. Center of Excellence for Placenta Accreta. In: Silver RM, , ed. Placenta Accreta Spectrum. CRC Press; 2016. . Chapter 9. In press
  Google Scholar
• 14 Silver RM, Fox KA, Barton JR , et al. Center of excellence for placenta accreta. Am J Obstet Gynecol 2015; 212 (5) 561-568
  CrossrefPubMedGoogle Scholar
• 15 Lo JS, Pickersgill A. Pregnancy after endometrial ablation: English literature review and case report. J Minim Invasive Gynecol 2006; 13 (2) 88-91
  CrossrefPubMedGoogle Scholar
• 16 El-Toukhy T, Hefni M. Pregnancy after hydrothermal endometrial ablation and laparoscopic sterilisation. Eur J Obstet Gynecol Reprod Biol 2003; 106 (2) 222-224
  CrossrefPubMedGoogle Scholar
• 17 ACOG Committee on Practice Bulletins. ACOG Practice Bulletin. Clinical management guidelines for obstetriciangynecologists. Number 81, May 2007. Obstet Gynecol 2007; 109 (5) 1233-1248
  CrossrefPubMedGoogle Scholar
• 18 Hologic Inc. . Novasure® Endometrial Ablation & Birth Control. MISC-03509–001; 2015 . Available at http://www.novasure.com/sites/novasure/files/NovaSure_and_Birth_Control_0.pdf . Accessed September 1, 2016
  PubMed
• 19 Hologic Inc. Novasure®: What to Expect. 2016 . Available at http://www.novasure.com/patients/what-expect-novasure-procedure . Accessed September 1, 2016
  PubMedGoogle Scholar
• 20 Johns Hopkins Health Library. Endometrial ablation. Available at http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gynecology/endometrial_ablation_92,p07774/ . Accessed September 1, 2016
  PubMedGoogle Scholar
• 21 Polis CB, Bradley SE, Bankole A, Onda T, Croft T, Singh S. Typical-use contraceptive failure rates in 43 countries with Demographic and Health Survey data: summary of a detailed report. Contraception 2016; 94 (1) 11-17
  CrossrefPubMedGoogle Scholar
• 22 Centers for Disease Control and Prevention. Effectiveness of Family Planning Methods. Infographic. 2014 . Available at http://www.cdc.gov/reproductivehealth/unintendedpregnancy/pdf/family-planning-methods-2014.pdf . Accessed September 1, 2016
  PubMedGoogle Scholar
• 23 Hologic Inc. NovaSure® Endometrial Ablation. Summary of Risks and Considerations. MISC-01532–001; 2015 . Available at http://www.novasure.com/sites/novasure/files/NovaSure_Patient_Risks-and-Considerations.pdf . Accessed September 1, 2016
  PubMedGoogle Scholar
• 24 Fromm C, Likourezos A, Haines L, Khan AN, Williams J, Berezow J. Substituting whole blood for urine in a bedside pregnancy test. J Emerg Med 2012; 43 (3) 478-482
  CrossrefPubMedGoogle Scholar
• 25 Mazouz S, Lee JK, Fernandez H. Evaluation of a urinary test as a diagnostic tool of a nonprogressive pregnancy. Fertil Steril 2011; 95 (2) 783-786
  CrossrefPubMedGoogle Scholar
• 26 Wilcox AJ, Baird DD, Dunson D, McChesney R, Weinberg CR. Natural limits of pregnancy testing in relation to the expected menstrual period. JAMA 2001; 286 (14) 1759-1761
  CrossrefPubMedGoogle Scholar
• 27 Hologic Inc. One Million Patients Choose Hologic's NovaSure® System Over Hysterectomy. 2009 . Available at http://investors.hologic.com/news?item=420 . Accessed September 1, 2016
  PubMedGoogle Scholar
• 28 Hologic Inc. Personal Communication with manufacturer. Data on file. Inquiry made September 22, 2016
  PubMedGoogle Scholar