Case Report of Placenta Percreta After Thermachoice Balloon Endometrial Ablation
Al-Sayegh H, Kuntal S, El-Garib A, Parveen S, Lewis S
Royal Gwent Hospital, Newport, United Kingdom
- All form of endometrial ablation should not be an option to treat menorrahgia in young women who have not completed their family
- To highlight the importance of advising about reliable contraception post endometrial ablation
Case notes of the patient reviewed
Literature search of risks associated with pregnancies post endometrial ablation
A 27 years old woman who had previous emergency caesarean section 3 years ago for failure to progress complicated with severe postpartum haemorrhage and admission to ITU.
She is known to have factor v leiden deficiency and history of pulmonary embolism suffered from menorrahgia, medical management failed and ended in having thermachoice endometrial ablation. She was strongly advised to have reliable method of contraception.
She fell pregnant and in her current pregnancy she had confirmed spontaneous rupture of membrane at 19 weeks gestation, offered termination but declined. Local SROM protocol was followed, and she was seen regularly in combined obstetrics and haematology clinic as she was on treatment dose of clexane. There was Multidisplinary meeting regarding timing of delivery as she had multiple admissions with abdominal pain, and the aim was to deliver her after 28 weeks gestation.
She presented at 27 weeks and 5 days with sepsis (abdominal pain, high temperature of 38 degrees, tachycardia and hypotension), had emergency caesarean section in the presence of both consultant anaesthetist and obstetrician. She had fundal placenta percreta and massive haemorrhage of 4 litres and ended in caesarean hysterectomy to control the bleeding.
Pregnancy after all form of endometrial ablation is associated with risks of morbid adhesion of placenta, uterine rupture, intrauterine growth restriction 1and premature rupture of membranes 2. Reliable methods of contraception should be advised.
- Bowling MR, Ramsey PS. Spontaneous uterine rupture in pregnancy after endometrial ablation. Obstet Gynecol. 2010 Feb; 115(2 Pt 2):405-6.
Hamar BD, Wolff EF, Kodaman PH, Marcovici I. Premature rupture of membranes, placenta increta, and hysterectomy in a pregnancy following endometrial ablation. J Perinatol. 2006 Feb; 26(2):135-7.