title: Placenta Percreta and Incomplete Uterine Rupture after Endometrial Ablation and Tubal Occlusion.
abstract: Endometrial ablation offers symptomatic relief for menorrhagia. Pregnancy after ablation is rare but is often complicated due to pregnancy loss, growth restriction, preterm premature rupture of membranes, preterm delivery, and morbidly adherent placentation, a dangerous complication that can result in hemorrhage, intensive care unit admission, and cesarean hysterectomy. We report a case of pregnancy conceived contemporaneously with endometrial ablation and tubal occlusion. Diagnosis of pregnancy was delayed due to low suspicion. Complications included cervical implantation and placenta percreta, necessitating hysterectomy with the fetus in situ. Intraoperatively, incomplete uterine rupture was noted. Abnormal neovascularization, fibrous adhesions, and anatomical distortion necessitated a complex surgical approach. Women undergoing endometrial ablation must be thoroughly counseled about the serious risks of postablation pregnancy, the need for contraception, and the risk of sterilization failure. Pregnancy should remain in the differential diagnosis for women of reproductive age, regardless of tubal occlusion. Cases of placenta percreta should be referred early to centers of excellence with multidisciplinary teams.
authors.affiliation: Baylor College of Medicine, Houston, Texas.
authors.forename: Jaden R
authors.initials: JR
authors.lastname: Kohn
authors.affiliation: Department of Pathology, Baylor College of Medicine, Houston, Texas.
authors.forename: Edwina
authors.initials: E
authors.lastname: Popek
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, Houston, Texas.
authors.forename: Concepcion R
authors.initials: CR
authors.lastname: Diaz-Arrastia
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Guan
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Alireza A
authors.initials: AA
authors.lastname: Shamshirsaz
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Belfort
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Karin A
authors.initials: KA
authors.lastname: Fox
keywords: bilateral tubal sterilization; endometrial ablation; morbidly adherent placenta; placenta percreta; uterine rupture