Premature rupture of membranes, placenta increta, and hysterectomy in a pregnancy following endometrial ablation

Abstract

Endometrial ablation has become a popular method of managing menorrhagia. Pregnancy after endometrial ablation has a high rate of complications. We present the case of a parous woman with a history of endometrial ablation with preterm premature rupture of membranes. Despite the absence of established sonographic markers for abnormal placentation, placenta accreta was noted at the time of cesarean delivery. In women with history of endometrial ablation, the endometrium is not normal and may allow for more aggressive placental invasion or adherence. Consequently, the sonographic indices described for evaluating placenta accreta may not be present. We believe that placentation in women with prior endometrial ablations should be considered extremely high risk for placenta accreta or increta and managed accordingly when preparing for delivery.

Intraoperative Surgical Treatment of Undiagnosed Placenta Percreta

“…The most common risk factor for adherent placenta and placenta percreta is cesarean section. Besides cesarean delivery further risk factors are reported as multiparity, uterine fibroids, embolization of uterine fibroid, advanced maternal age, second-trimester serum levels of alpha-fetoprotein (AFP) and free beta-hCG greater than 2.5 multiples of the median without any anatomical malformation, hypertensive disorders, or smoking [5][6][7], any condition resulting in myometrial tissue damage such as previous myomectomy, endometritis, endometrial defects due to curettage resulting in Asherman syndrome [8], thermal ablation [9], and uterine artery embolization [10]. Such abnormalities include placenta previa as well as placenta accreta.…”

Demographic profile and high risk factors in morbidly adherent placenta

“…15 Placenta praevia without previous uterine surgery is associated with a 1-5% of placenta accreta. Besides advanced maternal age and multiparity, reported risk factors include any condition resulting in myometrial tissue damage followed by secondary collagen repair, such as previous myomectomy, endometrial defects due to vigorous curettage 16 , thermal ablation 17 and uterine artery embolization 18 .…”

Successful conservative management in placenta previa percreta involving urinary bladder

“…Placenta previa without previous uterine surgery is associated with a 1-5% risk of placenta accreta. Besides advanced maternal age and multiparity, other reported risk factors include any condition resulting in myometrial tissue damage followed by a secondary collagen repair, such as previous myomectomy, endometrial defects due to vigorous curettage resulting in Asherman syndrome, submucous leiomyomas, thermal ablation, and uterine artery embolization [14][15][16].…”