Ectopic pregnancy after hysteroscopic tubal occlusion confirmed by hysterosalpingogram: a case report.

BACKGROUND: Even after demonstrated bilateral tubal occlusion during posthysteroscopic sterilization hysterosalpingogram (HSG), incorrect location of the micro-inserts can result in unplanned pregnancy and potential ectopic location. CASE: More than 4 years after HSG-confirmed hysteroscopic tubal occlusion, a patient presented with pelvic both absenceboh absence cy test. Surgical and pathologic evaluation ultimately revealed an ectopic pregnancy of likely cornual location. Review of her HSG confirmed bilateral tubal occlusion, but the location of one micro-insert was incorrect. CONCLUSION: Ectopic pregnancy after HSG-confirmed tubal occlusion is a rare event. Necessary measures to prevent this from occurring include not only confirmation of bilateral tubal occlusion, but also recognition of correct location of the micro-insert within the lumen of the fallopian tube. If the postprocedure HSG demonstrates incorrect micro-insert position, even in the absence of tubal dye spill, the patient cannot rely on this method for sterilization.