Uterine defect in a twin pregnancy with a history of hysteroscopic fundal perforation.

A woman with a history of hysteroscopic resection of a uterine septum complicated by fundal perforation presented with a term twin pregnancy and spontaneous rupture of membranes. At cesarean, a 7-cm defect was present in the uterine fundus; the edges of the defect were scarred and without bleeding, suggesting a chronic process. Women with a history of fundal perforation during hysteroscopic resection of a uterine septum should be counseled regarding the possibility of a chronic defect and its potential implications. As more uterine septa are resected via the hysteroscope, our understanding of potential long-term complications will increase.