Our patient was a 35 year old. She was known to have Von Willebrand's disease type 1. Her 3 previous pregnancies had been uneventful and she had been treated with intranasal DDAVP and tranexamic acid for the week following each delivery prophylactically.
She was investigated for heavy menstrual bleeding. She stated she wished no more children because of previous severe post natal depression. She had Microwave Endometrial Ablation (MEA™).
A year after she was seen requesting termination of pregnancy at 12 weeks gestation, following this consultation it appears a decision was made to continue with the pregnancy.
She was admitted with vaginal bleeding several times during this pregnancy.
At 37 weeks she was admitted in labour, and went on to have a normal vaginal delivery. The placenta was retained. A manual removal of placenta was attempted in theatre but was unsuccessful, this was complicated by a significant postpartum haemorrhage, it did not respond to medical or preservative surgical management. She went on to have a total abdominal hysterectomy. Total blood loss was 12 litres. Histopathology showed placenta increta.
Endometrial ablation has become a less invasive alternative to hysterectomy for treatment of menorrhagia. Pregnancy following ablation can be complicated by intrauterine growth restriction and intrauterine death due to a scarred small uterus. It can also lead to uterine rupture or abnormal placentation. These complications can be life threatening to the patient and her unborn baby. Proper counselling prior to the procedure is of paramount importance.
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