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 pregnancy2 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.