Outcome of pregnancy following endometrial ablation

Pregnancy following endometrial ablation is uncommon, and the literature does not allow an estimation of the likelihood of complications. Women with Asherman's syndrome, which is regarded as similar to a postablation uterus, have a 30% chance of progressing to term delivery. We report four pregnancies following endometrial ablation, bringing the total number of published cases to 37. The outcomes are analyzed to provide evidence for patient counseling and for management of those women who are pregnant following endometrial ablation. Just over half of the reported pregnancies following endometrial ablation were therapeutically aborted, and an additional 11% aborted spontaneously. The 11 continuing pregnancies were complicated by perinatal death in 2 (18%) and intrauterine growth retardation in 5 (45%). There was premature rupture of membranes in 3 (27%), preterm delivery in 7 (64%), and placenta accreta in 6 (55%). Preterm deliveries were by emergency cesarean section, except in 1 case, and all placental adherence complications occurred in this group. Three women required hysterectomy. Only 4 (36%) continuing pregnancies reached term, and 3 of these were delivered by elective cesarean section. No term pregnancy had a third stage complication.