Interesting case of pregnancy with MEA and vaginal mesh repair

Case Study ZO, 48-years housewife, middle-eastern origin with limited English was referred to Gynaecology clinic with complaints of menorraghia and symptomatic prolapse since 5 years. She had five vaginal deliveries. She gave history of laparoscopic sterilization (done outside UK) and laparoscopic cholecystectomy. On examination she had laparoscopy scar, Stage-2 cystocele, rectocele and Uterovaginal prolapsed. Ultrasound pelvis was normal. She had Hysteroscopy, Endometrial Biopsy, MEA (microwave endometrial ablation), Antereo-post vaginal repair with mesh. At follow up she did not have prolapse but was 15 weeks pregnant. Antenatally she developed Gestational Diabetes mellitus, was treated with Insulin. She had serial growth scans; She underwent elective Caesarean section with partial salpingectomy. Expecting PPH & Morbidly adherent placenta, four units blood was cross matched, ready in theatre and consent for possible hysterectomy was taken. Placenta was digitally separated and salpingectomy was done. Patient went home on fourth postoperative day. Conclusion Maternal history of sterilization should be explored in more detail especially if it is done outside UK. Our case is unusual in that it had successful outcome with multi-disciplinary approach inspite of MEA, mesh repair, sterilization, diabetes, increased body mass index and advanced maternal age.