Pregnancy complicated by uterine synechiae after endometrial ablation

BACKGROUND: The use of endometrial ablation is becoming more common in the treatment of abnormal uterine bleeding. As a result, an increasing number of reproductive-aged women are electing to have an endometrial ablation. Women who undergo this procedure should be informed that desired fertility is a contraindication because endometrial ablation can significantly increase the risk of obstetric complications. This is the first reported pregnancy complicated by uterine synechiac in a patient with a history of an endometrial ablation (MEDLINE search, January 1985 to June 2004, key words "pregnancy," "obstetric," "endometrial ablation," "complications," and "hysteroscopy"). CASE: A 34-year-old multigravida was referred to labor and delivery at 24 and 2/7 weeks after ultrasound findings of a shortened cervix, multiple uterine synechiae, and multiple fetal anomalies. Two weeks after admission, she experienced preterm premature rupture of membranes with subsequent variable decelerations requiring delivery via classical cesarean. The fetal malformations were attributed to the multiple uterine synechiae caused by the previous endometrial ablation. CONCLUSION: This case illustrates the significant morbidity and mortality associated with a pregnancy complicated by uterine synechiae after an endometrial ablation. © 2005 by The American College of Obstetricians and Gynecologists.