Ultrasound-guided intrauterine methotrexate injection of a failed gestation occurring post-endometrial ablation: a case report.
BACKGROUND
Pregnancy following endometrial ablation carries significant risks, including spontaneous abortion, preterm delivery, and abnormal placental adherence. Surgical termination of pregnancy following endometrial ablation has an increased risk for failure and complications.


METHODS
A 29-year-old woman became pregnant following an endometrial ablation. The pregnancy resulted in a missed abortion; due to prior endometrial ablation, dilatation and curettage was felt to have greater than normal risk. Under ultrasound guidance, methotrexate was injected directly into the gestational sac. The pregnancy resolved with no complications.


CONCLUSIONS
There are significant risks associated with pregnancies occurring post-endometrial ablation and with termination of these pregnancies. Ultrasound-guided local injection of methotrexate appears to be a safe and effective option when termination is required.
Lee
Arden
A
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton AB.
Askew
Gordon
G
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton AB.
Gleason
Thomas
T
Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB.
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000030:Abortion, Missed / Q000000981:diagnostic imaging* / Q000628:therapy; D000328:Adult; D055356:Endometrial Ablation Techniques / Q000009:adverse effects*; D004717:Endometrium / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods; D008727:Methotrexate / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy; D011247:Pregnancy; D018084:Ultrasonography, Interventional / Q000379:methods*
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate