Placenta accreta and intrauterine fetal death in a woman with prior endometrial ablation: a case report.

BACKGROUND

Few cases of pregnancy following endometrial ablation have been reported. Placenta accreta and poor perinatal outcome are potential risks due to underlying endometrial destruction and uterine scarring.

CASE: A 41-year-old, white woman presented for initial prenatal care at 12 weeks, 3 years after endometrial ablation with resection of a leiomyoma. The patient's prenatal care was unremarkable until 20 weeks, when she presented with intrauterine fetal death. Labor was induced with misoprostol, and a stillborn fetus resulted. The placenta failed to deliver spontaneously after 6 hours and continuing doses of misoprostol. An attempt at manual extraction failed to demonstrate a clear cleavage plane between the placenta and endometrium. The patient underwent a hysterectomy for placenta accreta, which was confirmed on pathology.

CONCLUSION

Endometrial ablation may predispose the patient to abnormal placentation and intrauterine fetal death. Physicians should counsel their patients appropriately about the likelihood of this outcome.