RUPTURED ECTOPIC PREGNANCY IN AN AMENORRHEIC WOMAN AFTER TRANSCERVICAL RESECTION OF THE ENDOMETRIUM

EDITORIAL COMMENT: We all know to remember the possibility of ruptured ectopic pregnancy when a woman who ‘wears’ an intrauterine device or has had a tubal sterilization procedure performed, presents with abdominal pain; beta unit HCG assay and vaginal probe ultrasonography is then required for diagnosis when laparoscopy/ laparotomy is not clearly indicated on clinical grounds. This case report shows that ectopic pregnancy is also possible after endometrial resection, even when the woman has had cessation of menstruation. Since laparoscopy is usually employed to exclude uterine perforation and extrauterine trauma during endometrial ablation, at least during the surgeon's learning phase, it would seem wise to offer the woman simultaneous tubal sterilization during the procedure although this operation has approximately a 1 in 1,000 failure rate. Our endometrial ablationist reviewer informs us that at a meeting he attended in 1990 in the United States of America, 6 cases of ectopic pregnancy following endometrial resection were reported ‐ he could not recall whether or not they all had postresection amenorrhoea. These cases stress the need for pre and postoperative hormone therapy in women having endometrial resection. Simultaneous sterilization at the time of endometrial ablation certainly increases the duration of the operation but the patient is still able to leave hospital on the same day. Copyright © 1992, Wiley Blackwell. All rights reserved