Uterine rupture during pregnancy soon after a laparoscopic adenomyomectomy

Although laparoscopic adenomyomectomy may be a possible risk factor for uterine rupture in subsequent pregnancy, few reports have described it. A 35-year-old woman became pregnant 1 month after laparoscopic adenomyomectomy. At the 28th week, uterine contraction occurred, leading to intravenous ritodrine infusion. Severe abdominal pain and a non-reassuring fetal heart rate occurred abruptly and an emergency cesarean section was carried out. The uterus ruptured at the site of previous surgery of the uterine body, which was reconstructed. The mother and the infant did well postoperatively. We report the second case of uterine rupture during pregnancy subsequent to laparoscopic adenomyomectomy. A history of adenomyomectomy and a short interval to subsequent pregnancy may be risk factors for uterine rupture. (Reprod Med Biol 2007; 6 : 175–177)     

Uterine rupture: risk factors and pregnancy outcome

OBJECTIVES: This study aimed at determining risk factors and pregnancy outcome in women with uterine rupture. STUDY DESIGN: We conducted a population-based study, comparing all singleton deliveries with and without uterine rupture between 1988 and 1999. RESULTS: Uterus rupture occurred in 0.035% (n=42) of all deliveries included in the study (n=117,685). Independent risk factors for uterine rupture in a multivariable analysis were as follows: previous cesarean section (odds ratio [OR]=6.0, 95% CI 3.2-11.4), malpresentation (OR=5.4, 95% CI 2.7-10.5), and dystocia during the second stage of labor (OR=13.7, 95% CI 6.4-29.3). Women with uterine rupture had more episodes of postpartum hemorrhage (50.0% vs 0.4%, P<.01), received more packed cell transfusions (54.8% vs 1.5%, P<.01), and required more hysterectomies (26.2% vs 0.04%, P<.01). Newborn infants delivered after uterine rupture were more frequently graded Apgar scores lower than 5 at 5 minutes and had higher rates of perinatal mortality when compared with those without rupture (10.3% vs 0.3%, P<.01; 19.0% vs 1.4%, P<.01, respectively). CONCLUSION: Uterine rupture, associated with previous cesarean section, malpresentation, and second-stage dystocia, is a major risk factor for maternal morbidity and neonatal mortality. Thus, a repeated cesarean delivery should be considered among parturients with a previous uterine scar, whose labor failed to progress.     

Uterine rupture after laparoscopic myomectomy

Myomectomy is performed frequently to preserve or increase fertility, although the risk of future uterine rupture is a major concern of any surgery of the uterus. A 36-year-old woman underwent laparoscopic removal of a pendunculated myoma, and 6 weeks later she conceived after IVF. At 35.5 weeks' gestation she was admitted to the hospital because of abdominal pain. Cesarean section revealed rupture of the uterine wall at the site of the myoma. This and similar case reports indicate that inadequate laparoscopic suturing is not the only factor involved in rupture of the uterine wall during pregnancy after laparoscopic myomectomy.     

Uterine rupture in pregnancy: a five-year study

Background  

Uterine rupture during pregnancy is a rare occurrence that frequently results in high incidence of maternal and fetal morbidity and mortality.     

Uterine rupture during pregnancy following myomectomy via coelioscopy

A 33-year-old woman underwent a myomectomy via coelioscopy and then showed 5 years later a uterine rupture at the 32nd week of amenorrhea. The rupture was diagnosed after the echography, while there was no peritoneal maternal patency nor foetal consequence. After a cesarean and an uterine repair, the recovery of the mother was satisfactory but the newborn was to die at the 6th week of life. This obstetrical complication raises the problem of myomectomy via coelioscopy in young women, whose indications are being discussed.     

Steroid concentrations in human myometrial and placental tissues at week 39 of pregnancy

Endogenous levels of P, E1, and E2 were determined by radioimmunoassay in human myometrium and placenta at week 39 of pregnancy. In the myometrium, P and estrogens were higher in the inner layer near the placenta than in other zones. Higher E2/P ratios were found in placental sites. A large difference in the E2/P ratios was observed between placenta and corresponding adjacent myometrial area, indicating an easier diffusion of E2 from the site of its production.     

The obstetric fistula: factors associated with improved pregnancy outcome after a successful repair.

A retrospective study of 155 pregnant patients with obstetric fistulae was conducted to determine the factors associated with improvement in the pregnancy outcome. The successful repair of the fistula was associated with a reduced abortion rate (4.0%), incidence of premature rupture of the membranes (1.3%) perinatal mortality (13.0%) as well as an increase in the mean fetal birthweight and reduced incidence of low birth (20.3%). Antenatal supervision of pregnancy increased the acceptance rate for elective cesarean section and was associated with early referral of cases to hospital during labor. The patients having their first pregnancies since the onset of their fistulae delayed longest in labor at home (15.6 h) hence had the highest perinatal mortality and rate of recurrence of obstetric fistula. Therefore the successful repair of the obstetric fistula together with an aggressive drive to improve antenatal supervision especially directed at the younger patients will improve acceptance of the policy of elective cesarean delivery and therefore the overall pregnancy outcome among these patients.     

Uterine rupture in pregnancy subsequent to previous laparoscopic electromyolysis

Reports about uterine rupture in pregnancy subsequent to previous laparoscopic surgery are not frequent. This may be due to the lack of long term follow up of patients who had undergone this surgery rather than the rarity of this complication. A case of uterine rupture subsequent to laparoscopic myomectomy is reported. An increasing rate of the occurrence of this complication is reviewed in current literature, thus reiterating the need for more stringent selection criteria for patients who benefit from this surgical technique.     

宫角妊娠子宫破裂一例

<正>患者27岁,孕2产1,因"停经五月余,下腹隐痛7 h"于2015年10月9日收入江苏省苏北人民医院。7 h前患者出现下腹隐痛,至当地医院行超声检查示胎儿存活,考虑急性阑尾炎,未予特殊处理。后患者腹痛加剧,转入我院。转院途中患者出现面色苍白、大汗,并有一过性晕厥,无恶心呕吐,无腹泻,无肢体抽搐,无阴道流血流液。急诊超声示:腹腔     

Uterine rupture following conservative surgery for interstitial pregnancy.

A case of uterine rupture following conservative surgery for interstitial pregnancy is presented. Even though the uterine cavity was not opened during removal of the ectopic pregnancy, attenuation of the muscle lead to subsequent rupture of the uterus in the second trimester. The option for medical termination of ectopic pregnancies located in the cornual portion of tubes is discussed.     

Uterine rupture after re-implantation of fallopian tubes

Spontaneous uterine rupture in the second trimester of pregnancy with twins following a previous re-fertilization is very rare. A case of spontaneous cornual uterine rupture following re-implantation of the Fallopian tubes in a 35-year-old multigravid woman is described. The atypical clinical presentation and the findings at the operation are discussed.