Intrauterine adhesions as a risk factor for failed first-trimester pregnancy termination.
BACKGROUND
Risk factors for failed first-trimester surgical abortion include endometrial distortion caused by leiomyomas, uterine anomalies and malposition and cervical stenosis. This report introduces intrauterine adhesions as an additional risk factor.


METHODS
A multiparous woman presented for pregnancy termination at 6 weeks' gestation. Three suction-curettage attempts failed to remove what appeared to be an intrauterine pregnancy. Rising beta-hCG levels and concern for an interstitial ectopic pregnancy prompted a diagnostic laparoscopy and exploratory laparotomy without the identification of an ectopic pregnancy. After methotrexate treatment failed, the patient underwent ultrasound-guided hysteroscopy and suction curettage using a cannula with a whistle-cut aperture for the successful removal of a pregnancy implanted behind intrauterine adhesions.


CONCLUSIONS
Intrauterine adhesions are a cause of failed surgical abortion. Ultrasound-guided hysteroscopy may be required for diagnosis.
Luk
Janelle
J
Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA 02115, USA.
Allen
Rebecca H
RH
Schantz-Dunn
Julianna
J
Goldberg
Alisa B
AB
D000032:Abortion, Therapeutic / Q000009:adverse effects*; D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000601:surgery*; D000267:Tissue Adhesions / Q000150:complications; D017211:Treatment Failure; D014463:Ultrasonography; D014591:Uterine Diseases / Q000150:complications*; D014619:Vacuum Curettage / Q000009:adverse effects* / Q000379:methods
D018997:Chorionic Gonadotropin, beta Subunit, Human