title: Pregnancy following hysteroscopic sterilization at an Urban Abortion Clinic- A case series: Are We looking in the wrong places?
abstract: Hysteroscopic sterilization (HS) has become one of the most common permanent contraception methods in the U.S. However, recent evidence suggests that the failure rate may be higher than previously reported. We describe women with a history of HS presenting for abortion at a 3-site urban abortion clinic.
  
  
  
  Retrospective case series of patients with previous HS who presented to a 3-site urban abortion clinic for pregnancy termination from October 2012 to February 2015.
  
  
  
  In 28months, 9 patients with prior HS had failure of the method and then an abortion.
  
  
  
  This study identifies a number of failures from a setting previously unaccounted. It suggests that perhaps the failure rate is higher than previously reported. The cases here presented, from a 3-site urban abortion clinic over 28months, almost match and sometimes surpass the number of failures reported in multicenter case series in the literature. Surveys of other abortion clinics in the U.S. and elsewhere might also discover other patients whose HS had failed.
  
  
  
  We identified a number of hysteroscopic sterilization failures at termination of pregnancy at a 3-site urban abortion clinic. We hypothesize that the HS failure rate underestimates the true method failure because previous analysis have excluded cases such as these.
authors.affiliation: Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA. Electronic address: lhoyosma@med.wayne.edu.
authors.forename: Luis R
authors.initials: LR
authors.lastname: Hoyos
authors.affiliation: Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA. Electronic address: jleonpet@med.wayne.edu.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Leon-Peters
authors.affiliation: Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA. Electronic address: jberman@med.wayne.edu.
authors.forename: Jay M
authors.initials: JM
authors.lastname: Berman
authors.affiliation: Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA. Electronic address: mhertz@med.wayne.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Hertz
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D003267:Contraception / Q000379:methods; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008824:Michigan; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012189:Retrospective Studies; D013246:Sterilization, Tubal; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D014505:Urban Population
keywords: Abortion; Effectiveness; Essure; Failure; Hysteroscopic sterilization