Emergency peripartum hysterectomy: our 12-year experience

Objective

The aim of this study was to determine the incidence, indications and the risk factors and complications of emergency peripartum hysterectomy (EPH).

Methods

We analyzed retrospectively 44 cases of EPH performed at tertiary obstetric center between January 2001 and April 2013. Data related to demographics, reproductive histories, indications for EPH, and postoperative follow-up were obtained by analyses of hospital records.

Results

The overall incidence of EPH was 0.48 per 1,000 deliveries during the study period. The most common indications of EPH were abnormal placentation (50 %), uterine atony (36 %) and uterine rupture (9 %). All patients who underwent EPH with abnormal placentation had one or more previous cesarean sections (CS) except one. In our series, 24 cases (54 %) underwent total hysterectomy, most of which had the diagnosis of abnormal placentation (75 %), whereas subtotal hysterectomy was the choice of management of bleeding in cases with uterine atony (60 %). Maternal mortality was seen in 2 patients (4.5 %). The causes were disseminated intravascular coagulation in one and adult respiratory distress syndrome in the other patient. Perinatal mortality was observed in 7 patients (16 %). The causes for perinatal mortality were placental abruption in 4 and prematurity in 3 patients.

Conclusions

In our series, abnormal placentation was the most common indication for EPH. The risk factors for EPH were previous CS for abnormal placentation and placental abruption for uterine atony and peripartum hemorrhage. Limiting the number of CS deliveries would bring a significant impact on decreasing the risk of EPH.     

The association between isolated oligohydramnios at term and pregnancy outcome

Purpose

As conflicting data exist concerning the implications of isolated oligohydramnios on pregnancy outcome at term, we aimed to assess this association in low-risk pregnancies.

Methods

A retrospective cohort study of term pregnancies with sonographic finding of isolated oligohydramnios (amniotic fluid index (AFI) <5 cm) between 2007 and 2012. Outcome was compared to a control group of pregnancies with normal AFI (5–25 cm). Pregnancies complicated by thrombophilia, hypertension, diabetes, deviant fetal growth or chromosomal/structural abnormalities were excluded. Composite adverse outcome included CS/operative delivery due to non-reassuring heart rate (NRFHR), low Apgar score, umbilical artery pH < 7.10, neonatal intensive care admission, meconium aspiration syndrome, intubation or hypoxic-ischemic encephalopathy.

Results

Overall, 987 pregnancies complicated by isolated oligohydramnios were compared to 22,280 low-risk pregnancies with normal AFI. Isolated oligohydramnios was associated with a higher rate of induction of labor (27.7 vs. 3.7 %, p < 0.001), CS due to NRFHR (2.3 vs. 1.1 %, p < 0.01) and composite adverse outcome (9.7 vs. 7.1 %, p < 0.01). However, after adjusting for potential confounders as induction of labor and nulliparity using multivariable logistic regression analysis, isolated oligohydramnios was not found to be independently associated with increased risk for composite adverse outcome (OR 1.01, 95 % CI 0.80–1.27, p = 0.93).

Conclusion

Isolated oligohydramnios at term by itself is not associated with increased obstetrical morbidity.     

Tranexamic acid for the prevention of postpartum hemorrhage after cesarean section: a double-blind randomization trial

Object

Our purpose in conducting this study was to determine the efficacy of tranexamic acid (TXA) in reducing blood loss in patients after cesarean section (CS).

Method

A randomized, double-blind, case-controlled study was conducted on 174 primipara undergoing CS. 88 of them given 10 mg/kg TXA immediately before CS were compared with 86 others to whom TXA was not given. Blood loss was calculated from blood collected and measured during two periods: the first period was from placental delivery to end of CS and the second from the end of CS to 2 h postpartum. Vital signs such as BP, HR, RP, hemoglobin, platelet count, postoperative PT and PPT were tested in the two groups.

Results

Blood loss in the period between the end of CS and 2 h postpartum was significantly lower (p < 0.01) in the TXA group (46.6 ± 42.7) than in the control group (84.7 ± 80.2). The quantity of total blood from placental delivery to 2 h postpartum was also significantly reduced (p = 0.02) in the TXA group (379.2 ± 160.1) than in the control group (441.7 ± 189.5). However, the amount of blood loss in the period from placental delivery to the end of CS did not differ between the TXA and control groups (p = 0.17). PPH stopped in 65 women (75.6 %) in the control group and in 81 (92.0 %) in the TXA group (p < 0.01). No significant abnormal vital signs were observed after TXA administration. Mild, transient side effects occurred more often in the TXA group than in the control group.

Conclusion

Treatment with TXA is effective in reducing blood loss in patients undergoing CS. Although the study was not adequately powered to address safety issues, the observed side effects were mild and transient.     

Polycystic ovarian syndrome and congenital uterine anomalies: the hidden common player

Objective

To study the association between polycystic ovary syndrome (PCOS) and congenital uterine (Müllerian) anomalies in infertile patients. The ultimate aim was to check for a common factor linking both reproductive health problems.

Design

A prospective observational study.

Setting

Tertiary referral infertility center.

Subjects and methodology

3,900 infertile patients were included. The diagnoses of PCOS and uterine anomalies were made. Patients with or without PCOS were correlated to the presence or absence of uterine anomalies and statistically assessed.

Main outcome measures

Study of the prevalence of PCOS/uterine anomalies in the studied population and the ratio of coexistence.

Results

The prevalence of PCOS in the studied cohort was 10.48 %. 409 (10.48 %) patients were confirmed to have PCOS, while 204 (5.23 %) were with confirmed uterine anomalies. Of the patients with confirmed PCOS, almost one-third (n = 149, 31.4 %) had uterine anomalies, while in patients with confirmed uterine anomalies, almost three-fourths (n = 149, 73 %) had PCOS.

Conclusions

There is evident association between PCOS and uterine anomalies in infertile patients. We suggest a genetic rather than a developmental defect to be a possible common player for the development of both PCOS and uterine anomalies.     

Placental Thickness: Its Correlation with Ultrasonographic Gestational Age in Normal and Intrauterine Growth-Retarded Pregnancies in the Late Second and Third Trimester

Objective

The aim was to study the correlation of placental thickness, measured at the level of the umbilical cord insertion, with the ultrasonographic gestational age in normal and IUGR pregnancies in the late second and third trimester.

Materials and Methods

A total of 498 patients were observed for correlation of the placental thickness with ultrasonographic gestational age and their outcomes by dividing them into Group A (outcome fetal weight < 2,500 g, n = 122) and Group B (fetal weight > 2,500 g, n = 376). The mean placental thickness was calculated at the umbilical cord insertion in both groups along with ultrasonographic fetal age and estimated fetal weight. The mean values of placental thickness along with respective standard deviation were calculated from the 24th to 39th week of gestational age.

Results

A positive correlation was observed between placental thickness and ultrasonographic gestational age in both groups (p value of 0.01), with Pearson’s correlation coefficient (“r”) values of 0.325 in Group A and 0.135 in Group B. Regression analysis yielded linear equations of relationship with placental thickness and gestational age in both groups. The placental thickness was also found to be lower in Group A between 26 and 27 weeks and 30 and 31 weeks, having mean values of 2.48 ± 0.063 cm (p value of 0.042) and 2.76 ± 0.552 (p value of 0.05) in Group A as compared to 3.04 ± 0.25 and 3.13 ± 0.183 cm in Group B.

Conclusions

Placental thickness measured at the level of umbilical cord insertion can be used as an accurate sonographic indicator in assessment of gestational age in singleton pregnancies because of its linear correlation.     

Characterizing the need for re-laparotomy during puerperium after cesarean section

Objective

As inconsistency exists concerning the rate and risk factors for re-laparotomy after cesarean section (CS), we aimed to determine the incidence, risk factors and indications for re-laparotomy after CS.

Methods

This is a retrospective study. Women underwent re-laparotomy following CS were compared to a control group in a 1:3 ratio. Demographic, obstetrical and surgical data were analyzed. CS complications were defined as intra-operative abnormal hemorrhage, summoning surgical personnel, inverted T incision, uterine and/or hypogastric arteries ligation or cesarean hysterectomy.

Results

Overall, 35,779 women delivered during the study, of them 7,926 by CS (22.1 %) and 62 patients (0.7 %) underwent re-laparotomy. Re-laparotomies occur during the first 24 h, first week and beyond it, following CS in 64.5, 22.6 and 12.9 %, respectively. Previous abdominal/pelvic surgery (14.5 vs. 8.1 %, p < 0.01), emergent surgery (24.2 vs. 13.4 %, p = 0.04), intra-operative complications (26.8 vs. 0.5 %, p < 0.001), post-operative complication (40.7 vs. 0.5 %, p < 0.001) and adhesions (65.5 vs. 33.3 %, p < 0.001) were significantly increased in the study group. Indications for re-laparotomy varied according to the interval elapsed to the re-laparotomy with post-partum hemorrhage (27.4 %) being the leading indication in the early period.

Conclusion

Risk factors for re-laparotomy following CS can be recognized and are mainly associated with previous abdominal and/or pelvic surgeries and intra-operative adhesions.     

Uterine Artery Notching on Color Doppler Ultrasound and Roll over Test in Prediction of Pregnancy Induced Hypertension

Objective

To study the role of uterine artery notch on color Doppler ultrasound and roll over test in prediction of PIH.

Methods

100 women with high risk pregnancies were studied for presence or absence of uterine artery diastolic notch by Doppler ultrasound at 16–28 weeks. Same women were then subjected to roll over test at 28–32 weeks.

Results

The primary outcome was that uterine diastolic notching alone and combined together with roll over test shows a high specificity (98.53%) for predicting PIH than roll over test (76.47%) alone. PPV of uterine artery diastolic notching (83.33%) was higher than roll over test alone (54.29%) and both tests combined together (80%).

Conclusion

After analyzing all the results, it has been concluded that uterine artery Doppler notching is better predictor for PIH than roll over test or even combined Doppler + Roll over test together.     

Prediction of dystocia-related cesarean section risk in uncomplicated Taiwanese nulliparas at term

Purpose

We aimed to assess risk factors for dystocia-related cesarean section (CS) in uncomplicated Taiwanese nulliparas at term

Methods

We reviewed 1,272 deliveries by 1 obstetrician in a Taiwanese hospital between February 2004 and December 2011. These parturients were nulliparas with singleton pregnancies ≥37 weeks gestation who had liveborn cephalic deliveries. The CS group consisted of parturients with dystocia-related CS for the following indications: prolonged latent phase, failure to progress, or arrest of descent. Eight confounding variables [maternal age, height, weight, body mass index (BMI) in labor, gestational age, infant birth weight, gender, and cervical dilatation] were obtained from the medical records. Multivariate logistic regression analysis was used to determine the association between each variable and route of delivery. A predictive formula for CS probability was generated using a logistic regression model.

Results

Overall 15.0 % of nulliparas in our population underwent CS. Logistic regression analysis revealed a significant association between maternal BMI and CS (adjusted OR 1.112; 95 % CI 1.065–1.161; P < 0.001). The association between maternal age and CS was also statistically significant (adjusted OR 1.074, 95 % CI 1.033–1.116, P = 0.001). Maternal height, weight in labor, gestational age, infant birth weight, gender, and cervical dilatation were not significantly associated with the route of delivery. A predictive formula for CS probability was developed based on a combination of maternal BMI and age.

Conclusions

Our results show that maternal age and BMI in labor are significantly associated with dystocia-related CS in uncomplicated Taiwanese nulliparas at term. We develop a practical formula to predict the probability for CS. Using this formula, obstetricians can estimate the risk of CS according to maternal age and BMI in labor.     

Pregnancies in women with uterine malformation, treated obstruction of hemivagina and ipsilateral renal agenesis

Purpose

The aim of this study was to evaluate the outcome of pregnancies in women who had uterine malformation and surgically treated obstructed hemivagina with ipsilateral renal agenesis.

Methods

The study group comprised 21 women with malformed uterus (12 didelphic, 6 septate and 3 bicornuate uterus). All of them had a history of surgical excision of the longitudinal vaginal septum caused obstructed hemivagina and ipsilateral renal agenesis. All pregnancies and possible surgical interventions were evaluated during the follow-up period (median 13.2 years).

Results

Thirteen out of 21 women attempting pregnancy conceived. They produced 22 pregnancies, 17 (77 %) were contralateral to the treated obstructed hemivagina and unilateral renal agenesis. The median interval between surgical treatment of obstructed hemivagina and the first pregnancy was 10.5 years. Twenty (91 %) pregnancies ended in delivery of a living infant. Preeclampsia (14 %), preterm delivery (36 %), high frequency (38 %) of fetal breech presentation and the cesarean section rate (67 %) were found.

Conclusions

Accurate diagnosis and appropriate surgery to open an obstructed hemivagina in adolescence assure fertility. Preterm birth is associated with malformed uterus and unilateral renal agenesis may predispose to preeclampsia.     

Intrapartum Amnioinfusion in Meconium-Stained Liquor: A Case–Control Study

Objective

The aim of this study was to investigate perinatal outcome and the rate of cesarean section (CS) following intrapartum amnioinfusion in women with meconium-stained amniotic fluid (MSAF).

Method

A total of 100 women at term in labor with meconium were randomized to infuse transcervical intrapartum amnioinfusion with saline (50) and routine obstetrical care (50). Perinatal outcome and obstetric outcome were recorded and analyzed in both groups by means of Chi-square test.

Result

The CS rate due to fetal distress was 40.0 % in the control group and 20.0 % in the study group. The difference was statistically significant (P < 0.01). Respiratory distress of the neonate was significantly less common in the study group than in the control group (4.0 % vs. 12 %; P = 0.0349).

Conclusion

Amnioinfusion in cases of meconium-stained liquor significantly improved neonatal outcome and CS rate without increasing any maternal and fetal complications.     

MR angiography demonstrates a positive correlation between placental blood vessel volume and fetal size

Purpose

While intrauterine growth restriction is often associated with placental dysfunction or abnormal morphology, the link between fetal weight and the placental delivery capacity of blood has not been studied in detail. The purpose of this study was to investigate the relationship between the fetal placental blood volume (FPBV) and fetal length, fetal weight and fetal head circumference using a non-invasive approach.

Methods

Placentas from normal pregnancies terminated with elective cesarean section were included. The entire fetal-side placental vasculature was filled with a solution of a gadolinium-containing contrast agent, followed by magnetic resonance angiography. FPBV was calculated from the complete 3D dataset as the sum of high-intense voxels. Areas that appeared different than the main part of the placenta were marked and evaluated by histology. FPBV of each placenta was compared to the fetal measures at birth: weight, length and head circumference. FPBV was also compared to placental weight at birth.

Results

We found that FPBV correlated linearly with fetal weight (p = 0.02) and fetal head circumference (p = 0.03), but found no correlation between the calculated placental blood vessel volume and the placental weight at birth. Histology revealed no pathophysiological findings in any cases. The marked areas were all those of infarctions or fibrinous sedimentation.

Conclusion

Interestingly, we found a positive correlation between FPBV and fetal size. Fetal size was measured in fetal weight and fetal head circumference. Fetal length did not correlate with FPBV. Further studies are warranted to investigate this relationship in pregnancies with intrauterine growth restriction, and whether MRI angiography (without gadolinium-containing agents) is suitable as a novel diagnostic modality for placental dysfunction.     

Perioperative adverse events associated with pelvic organ prolapse repair by nerve-preserving sacropexy: an analysis of 768 cases over a 10-year period

Purpose

Differences in hemodynamic changes during a cesarean section (CS) between twin and singleton pregnancies are poorly defined. The Non-Invasive Cardiac System (NICaS) is an impedance device that measures cardiac output (CO) and its derivatives. We compared maternal cardiac parameters using NICaS? in singleton and twins before and during delivery, as well at the early puerperium in healthy women undergoing CS at term.

Methods

This prospective longitudinal study included women with twin (n = 27) or singleton pregnancies (n = 62) whose hemodynamic parameters were assessed by NICaS before an elective CS, after spinal anesthesia, immediately after delivery, after fascia closure, and within 24–36 and 48–72 h postpartum.

Results

By 24–36 h postpartum, the mean arterial pressure and the total peripheral resistance equaled preoperative values in both groups. The CO increased throughout the CS and peaked immediately after delivery in the singleton group (P < 0.0001), after which it abruptly began to decline until reaching a nadir 24–36 h after delivery (P < 0.0001), while it remained steady throughout the CS and then dropped until 24–36 h after delivery in the twin group (P < 0.05). None of the studied parameters differed significantly between the groups for the 24–36 and 48–72 h postpartum measurements.

Conclusions

Hemodynamic parameters immediately before, during and shortly after CS in singleton and twin pregnancies are equivalent. Further evaluations of the value of NICaS? in assessing cardiovascular-related pregnancy complications are warranted.

     

Gestational diabetes mellitus in twin pregnancies is not associated with adverse perinatal outcomes

Objective

To investigate the influence of gestational diabetes mellitus (GDM) on maternal and neonatal outcomes in twin pregnancies.

Methods

A retrospective population-based study was conducted, comparing maternal and neonatal outcome in women carrying twins with and without GDM. Deliveries occurred in a tertiary medical center between the years 1988 and 2010. Multivariable analysis was used to control for confounders.

Results

The study population included 4,428 twin pregnancies, of these 341 (7.7 %) were complicated with GDM. Twin pregnancies complicated with GDM had higher rates of fertility treatment, chronic hypertension, preeclampsia and cesarean deliveries (CD). Nevertheless, using a multivariable analysis, with CD as the outcome variable, controlling for confounders such as maternal age, fertility treatments and hypertensive disorders, GDM in twins was not found to be an independent risk factor for CD (adjusted OR = 1.8, 95 % CI 0.9?1.4; P = 0.18). Rates of low 5 min Apgar scores (<7) and perinatal mortality were lower among twins with GDM (2.9 % vs. 5.3 %, OR = 0.5, 95 % CI 0.3?0.8 0; P = 0.005 and 2.3 % vs. 4.4 %, OR = 0.5, 95 % CI 0.3–0.8; P = 0.005, respectively).

Conclusion

In our population, GDM in twin pregnancies was not associated with increased rates of adverse perinatal outcomes. In addition, GDM was not found to be an independent risk factor for CD in twin pregnancies.     

Independent association between uterine malformations and cervical insufficiency: a retrospective population-based cohort study

Objective

The purpose of our study was to explore maternal and fetal outcomes in the second and third trimester in women with uterine malformations.

Study design

This was a retrospective population-based cohort study including women with a diagnosis of uterine malformation arised from workup for infertility or recurrent pregnancy loss, was accidental during pregnancy, or was noticed at the time of cesarean delivery.

Results

A total of 280,721 pregnancies met the inclusion criteria and were divided into two study groups: (1) pregnancies in women with uterine malformations (n = 1099); and (2) controls (n = 279,662). The rate of women presenting uterine malformations was 0.39%. The prevalence of cervical os insufficiency was significantly higher in women with a uterine malformation than in the control group (3.6 vs. 0.4%, p < 0.001). A multivariate analysis, performed to evaluate risk factors for cervical insufficiency in women with uterine malformations. Mullerian anomalies (OR 6.19, 95% CI 4.41–8.70, p < 0.001), maternal age (OR 1.05, 95% CI 1.04–1.06, p < 0.001), recurrent abortions (OR 12.93, 95% CI 11.43–14.62, p < 0.001), and ethnicity (OR 2.86, 95% CI 2.454–3.34, p < 0.001) were found to be independently associated with the development of cervical insufficiency.

Conclusion

Uterine anomalies have a strong association with cervical insufficiency. Women with uterine anomalies have an increased risk to develop pregnancy complications that arise from a loss in cervical function during the midtrimester or early third trimester.

     

Patient-reported quality-of-life and sexual-function outcomes after laparoscopic supracervical hysterectomy (LSH) versus total laparoscopic hysterectomy (TLH): a prospective,questionnaire-based follow-up study in 915 patients

Purpose

To compare patient-reported quality-of-life and sexual function outcomes in women after laparoscopic supracervical hysterectomy (LSH) or total laparoscopic hysterectomy (TLH) for benign uterine disease.

Methods

Out of a cohort of 1,952 patients from a previous implementation study of LSH and TLH, 1,886 patients who had not undergone intraoperative conversion to laparotomy or were ineligible for other reasons were invited by mail to participate in this prospective, questionnaire-based follow-up study.

Results

Of the 915/1,952 (48.5 %) survey respondents included in the analysis, 788 (86.1 %) and 127 (13.9 %) had undergone LSH or TLH, respectively. Women undergoing LSH reported significantly lower pain levels (p = 0.037) and faster partial (p = 0.015) and complete (p < 0.001) resumption of normal daily activities compared to those undergoing TLH. As regards sexual function, women undergoing LSH resumed sexual activity significantly sooner (p = 0.018), rated sexual desire as higher (p = 0.023), and reported more frequently that their sexual life had improved postoperatively (p = 0.008) than did women undergoing TLH.

Conclusions

Women undergoing LSH for benign uterine disease may have better outcomes regarding certain quality-of-life and sexual function parameters than women undergoing TLH for benign uterine disease.     

The risk of placenta accreta following primary cesarean delivery

Objective

To (a) evaluate the risk for placenta accreta following primary cesarean section (CS), in regard to the stage of labor, the cesarean section was taken (elective prelabor vs. unplanned during labor); and (b) investigate whether the association between placenta accreta and maternal and neonatal complications is modified by the type of the primary CS.

Study design

In a population-based retrospective cohort study, we included all singleton deliveries occurred in Soroka University Medical Center between 1991 and 2015, of women who had a history of a single CS. The deliveries were divided into three groups according to the delivery stage the primary CS was carried out: ‘Unplanned 1’ (first stage—up to 10 cm), ‘Unplanned 2’ (second stage—10 cm) and ‘Elective’ prelabor CS. We assessed the association between the study group and placenta accreta using logistic generalized estimation equation (GEE) models. We additionally assessed maternal and neonatal complications associated with placenta accreta among women who had elective and unplanned CS separately.

Results

We included 22,036 deliveries to 13,727 women with a history of one CS, of which 0.9% (n = 207) had placenta accreta in the following pregnancies: 12% (n = 25) in the ‘Unplanned 1’ group, 7.2% (n = 15) in the ‘ Unplanned 2’ group and 80.8% (n = 167) in the ‘elective’ group. We found no difference in the risk for subsequent placenta accreta between the groups. In a stratified analysis by the timing of the primary cesarean delivery, the risk for maternal complications, associated with placenta accreta, was more pronounced among women who had an unplanned CS (OR 27.96, P < 0.01) compared to women who had an elective cesarean delivery (OR 13.72, P < 0.01).

Conclusions

The stage in which CS is performed has no influence on the risk for placenta accreta in the following pregnancies, women who had an unplanned CS are in a higher risk for placenta accrete-associated maternal complications. This should be taken into consideration while counselling women about their risk while considering trial of labor after cesarean section.

     

The impact of advanced maternal age on the outcome of twin pregnancies

Purpose

To assess the effect of advanced maternal age on the obstetrics and neonatal outcome of twin pregnancies.

Methods

A retrospective study of 716 dichorionic–diamniotic twin pregnancies delivered at our institute. The study population was divided into two groups: women aged 35–39 years (group A, n = 142) and women aged ≥ 40 years (Group B, n = 48). The control group consisted of women younger than 35 years (group C, n = 516).

Results

The rate of cesarean section (CS) was significantly higher among women older than 35 years compared to the control group (A 76.8% and B 87.5% vs C 65.7%, P = 0.001). Women older than 35 years were also at higher risk for developing hypertensive disorders (A 7.0%, B 14.6%, vs C 5.4%, P = 0.04). On multivariate regression analysis, maternal age was found to be independently associated with a higher rate of CS (odds ratio vs reference group C: group A 1.6, 95% CI 1.08–2.6; group B 3.2, 95% CI 1.3–7.8). There was no difference between the groups in the rate of neonatal complications.

Conclusion

Women with twin pregnancy, older than 35 years, have a significantly higher rate of CS and hypertensive disorder. This rate increases with maternal age, with no increased rate of neonatal complications.

     

Pregnancy after uterine artery embolization for the treatment of myomas: a case series

Purpose

Uterine artery embolization (UAE) has become an alternative therapy for the treatment of symptomatic myomas. The questions of fertility and pregnancy outcome after uterine artery embolization are still not answered. The study presents the results of pregnancies after UAE. The main goal was to evaluate the course of these pregnancies and concentrate on possible complications.

Methods

This was a prospective study from June 2009 till October 2011. Patients with symptomatic uterine myomas were included. The evaluation of the symptoms was done by quality of life questionnaire and bleeding charts. UAE was performed by superselective microcatheterization technique. Women still planning pregnancy were included in the study after signing detailed informed consent. Pregnant women after UAE were followed as high-risk pregnancies.

Results

A total of 98 patients underwent uterine artery embolization for symptomatic myomas; 21 expressed their wish to become pregnant, out of which 6 had successful spontaneous conception (23.08 %) and 1 patient was pregnant twice, and altogether there were seven pregnancies. During gestation and delivery, there was no serious complication. There was one missed abortion and one placental retention. Myomas did not show growth pattern during pregnancy.

Conclusions

Data from further prospective, randomized trials comparing fertility and pregnancies after UAE with other treatment modalities are needed. UAE, with the new techniques of superselective microcatheterization, could be, in the future, a possible approach even in women with future maternity plans.     

Uterine rupture at 33rd week of gestation after laparoscopic myomectomy with signs of fetal distress. A case report and review of literature

Objective

We describe a case of uterine rupture (UR) during pregnancy after laparoscopic myomectomy (LM) and discuss the risk factors of UR.