Pregnancy after endometrial ablation: a systematic review

Area of Science:

• Reproductive Medicine
• Gynecologic Surgery
• Obstetrics

Background:

• Limited data exists on pregnancy outcomes following endometrial ablation.
• Pregnancies after this procedure are rare but carry potential risks.

Purpose of the Study:

• To systematically review pregnancy outcomes after endometrial ablation.
• To provide physicians with data for counseling women considering the procedure.

Main Methods:

• Searched MEDLINE, Embase, Cochrane, and ClinicalTrials.gov through January 2017.
• Included published and unpublished literature on pregnancy after endometrial ablation or resection.
• Extracted and analyzed data on preconception characteristics and pregnancy outcomes.

Main Results:

• Identified 274 pregnancies from 99 sources, predominantly case reports.
• 85% of pregnancies in trial/observational studies resulted in termination, miscarriage, or ectopic pregnancy.
• Continuing pregnancies showed high rates of preterm delivery, C-section, hysterectomy, and morbidly adherent placenta.

Conclusions:

• Pregnancies after endometrial ablation have a high rate of serious complications.
• High-quality evidence is limited, suggesting potential publication bias.
• Women should be informed of risks and counseled to use reliable contraception.