April 8th, 2020

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Pregnancy After Endometrial Ablation: A Report of Three Cases
Authors:  Isabelle Roux, M.D., Mausumi Das, M.D., Hervé Fernandez, M.D., and Xavier Deffieux, M.D., Ph.D.
BACKGROUND: Pregnancies after endometrial ablation (EA) are rare and are associated with high morbidity, especially in the second and third trimesters.

CASE: We report 3 cases of pregnancy after EA in which severe complications occurred during the first trimester. The first case concerns an unexpected pregnancy after EA in a 50-year-old woman. Hysterectomy via laparotomy was needed because of heavy bleeding and severe anemia. Pathology showed a complete hydatidiform mole without invasion. Ultrasound-guided in situ methotrexate injection could be a nonsurgical alternative to terminate an intrauterine pregnancy after EA when the pregnancy is located within uterine synechiae, as shown by the second case. The third case presented as an accreta placentation mimicking hyperplastic myometrial invasion in a 46-year-old patient.

CONCLUSION: Because of the high morbidity of these pregnancies that could still occur after EA, patients need contraception after EA, and concomitant hysteroscopic sterilization should be proposed at the same time.
Keywords:  endometrial ablation, loop resection, tubal sterilization
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