Intrauterine adhesions as a risk factor for failed first-trimester pregnancy termination.


BACKGROUND Risk factors for failed first-trimester surgical abortion include endometrial distortion caused by leiomyomas, uterine anomalies and malposition and cervical stenosis. This report introduces intrauterine adhesions as an additional risk factor. CASE A multiparous woman presented for pregnancy termination at 6 weeks' gestation. Three suction-curettage attempts failed to remove what appeared to be an intrauterine pregnancy. Rising beta-hCG levels and concern for an interstitial ectopic pregnancy prompted a diagnostic laparoscopy and exploratory laparotomy without the identification of an ectopic pregnancy. After methotrexate treatment failed, the patient underwent ultrasound-guided hysteroscopy and suction curettage using a cannula with a whistle-cut aperture for the successful removal of a pregnancy implanted behind intrauterine adhesions. CONCLUSION Intrauterine adhesions are a cause of failed surgical abortion. Ultrasound-guided hysteroscopy may be required for diagnosis.

Cite this paper

@article{Luk2007IntrauterineAA, title={Intrauterine adhesions as a risk factor for failed first-trimester pregnancy termination.}, author={Janelle Luk and Rebecca H Allen and Julianna Schantz-Dunn and Alisa B. Goldberg}, journal={Contraception}, year={2007}, volume={76 4}, pages={331-3} }