Late complications of operative hysteroscopy: predicting patients at risk of uterine rupture during subsequent pregnancy

Sentilhes, Loïc; Sergent, F.; Roman, Horace; Verspyck, É.; Marpeau, L.

doi:10.1016/j.ejogrb.2004.10.010

Cited by 92 publications

(67 citation statements)

References 27 publications

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“…DCBx was also found to be more accurate than office endometrial biopsy in the evaluation of treatment response for progestin-containing intrauterine devices [85]. Frequent use of a hysteroscopic biopsy of the endometrium may adversely impact on future pregnancy outcomes because of the destruction of the basal layer of the endometrium [86], the subsequent replacement of the endometrial lining with fibrosis [87], and potential thermal injury to the myometrium [88].…”

Section: Monitoring Of Progestin Therapymentioning

confidence: 99%

Progestins in the Fertility-Sparing Treatment and Retreatment of Patients With Primary and Recurrent Endometrial Cancer

Nam

2015

The Oncologist

109

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Endometrial cancer is the most common gynecologic cancer in developed countries. Approximately 3%-14% of endometrial cancers are diagnosed in young women under 40 who want to preserve their fertility. The incidence of endometrial cancer in this age group is increasing, for which fertility-sparing therapy is increasingly used because it is one of the most important quality of life issues in these women. Progestin therapy is the most common type of fertility-sparing therapy. In this review, the most up-to-date findings regarding fertility-sparing progestin therapy for young women with primary and recurrent endometrial cancer is addressed in terms of diagnosis, treatment, follow-up, and oncologic and reproductive outcomes. Fertility-sparing progestin therapy is highly effective in selected young women with primary and recurrent endometrial cancer. The selection of appropriate patients through comprehensive pretreatment evaluation is of paramount importance to achieve the best outcomes without compromising survival. Because of the high rate of recurrence after successful fertility-sparing therapy, close surveillance is mandatory, and prophylactic hysterectomy is the best option for patients who have completed family planning. Pregnancy outcomes are very promising with the aid of assisted reproductive technologies. Continuous daily oral medroxyprogesterone acetate and megestrol acetate are the preferred progestins for fertility-sparing therapy, but future studies should be performed to determine the optimal dose and treatment duration of these agents. The Oncologist 2015; 20:270-278 Implications for Practice: In young women with endometrial cancer, the cure rate is very high.Therefore, the efficacy of treatment should not be limited to the oncologic outcomes.The quality-of-life issue is as important as oncologic outcomes in these patients. Fertility preservation is one of the most important quality-of-life issues. Based on the results of numerous studies, fertility-sparing progestin therapy can be safely performed in endometrioid adenocarcinoma confined to the endometrium. It also can be reasonably recommended to selected women with more advanced disease and recurrent disease. However, careful follow-up is important because of the high rate of recurrence.

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Section: Monitoring Of Progestin Therapymentioning

confidence: 99%

Progestins in the Fertility-Sparing Treatment and Retreatment of Patients With Primary and Recurrent Endometrial Cancer

Nam

2015

The Oncologist

109

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“…The interval between operative hysteroscopy and subsequent pregnancies complicated by uterine rupture varies between 1 month and 5 years according the literature. 13 In our case, the first rupture occurred 2 years after the initial operation, and subsequent ruptures occurred at 1-to 2-year intervals.…”

Section: Discussionmentioning

confidence: 99%

“…Sentilhes et al reported that hysteroscopic metroplasty increases the risk of uterine rupture during subsequent pregnancies and that recent uterine perforation and the use of electrosurgery also increases this risk. 13 However, these complications cannot be considered as independent risk factors. Electrosurgery increases the risk of thermal myometrial vascular damage and weakening of the tissue, which may cause deep tissue necrosis similar to what is observed during laparoscopic myomectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Some investigators suggest close follow-up using sonography but have been unable predict uterine rupture. [13][14][15] Prophylactic caesarean section would not have prevented the complications in this case. Therefore, until a reliable predictive method is introduced, patients must be informed about possible symptoms of uterine rupture, and the physician must be aware of fetal and maternal well-being.…”

Section: Discussionmentioning

confidence: 99%

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Recurrent uterine rupture after hysterescopic resection of the uterine septum

Ergenoğlu

Yeniel

Yıldırım

et al. 2013

International Journal of Surgery Case Reports

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a b s t r a c t INTRODUCTION: Uterine rupture after hysteroscopic septum resection is a rare complication, and its frequency is reported to be approximately 1-2.7%. Uterine perforation and monopolar resection during hysteroscopy are well-known risk factors for subsequent uterine rupture during pregnancy. PRESENTATION OF CASE:We present a case of recurrent uterine ruptures during consecutive pregnancies in a patient who had undergone hysteroscopic septum resection for recurrent pregnancy loss. DISCUSSION: Recurrent uterine rupture due to hysteroscopic septum resection in pregnancy is a very rare condition. In the present case we noted that the first two uterine ruptures resulted from uterine contractions; however, the third rupture occurred spontaneously and earlier in gestation. As each uterine rupture occurred earlier than the rupture in the previous gestation, a history of uterine rupture during pregnancy should raise provider suspicion about the possibility of earlier uterine rupture recurrence. CONCLUSION: Uterine rupture may occur in pregnancies after hysteroscopic resection of the uterine septum. However, if a patient has a history of uterine rupture during previous pregnancies, the risk of uterine rupture may increase for earlier gestational ages in subsequent pregnancies. The patient must be informed about both the risks of uterine rupture during pregnancy after hysteroscopic septum resection and that recurrent ruptures may occur at earlier gestational weeks than during previous pregnancies.

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“…There are, however, several case reports of uterine rupture after laparoscopic myomectomy or hysteroscopic surgery [30][31][32]. Sentilhes et al [33] reviewed the literature on uterine rupture after hysteroscopic surgery and found 14 cases. They concluded that hysteroscopic metroplasty places the patient at high risk for uterine rupture.…”

Section: Aetiologymentioning

confidence: 98%

Uterine rupture: the road ahead?

Lombaard

2006

Eur Clinics Obstet Gynaecol

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The worldwide increase in caesarean sections, as well as that in laparoscopic and hysteroscopic surgery, augments the risk for women to suffer a uterine rupture. Also the use of misoprostol for the termination of pregnancy and induction of labour, particularly in developing countries, contributes to the greater incidence of uterine rupture. In developing countries, again, neglected obstructed labour remains a very frequent cause of uterine rupture. Diagnosis of uterine rupture may be difficult and, if made too late, serious and even devastating complications may follow, culminating in infant and/or maternal death. A high index of suspicion is indicated when dealing with women at risk. Options in terms of managing uterine rupture include simple repair of the tear, subtotal, and total hysterectomy. Counselling women before and after surgical interventions on the genital tract, especially caesarean section on request, should include information concerning the subsequent risk of uterine rupture.

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Late complications of operative hysteroscopy: predicting patients at risk of uterine rupture during subsequent pregnancy

Cited by 92 publications

References 27 publications

Progestins in the Fertility-Sparing Treatment and Retreatment of Patients With Primary and Recurrent Endometrial Cancer

Progestins in the Fertility-Sparing Treatment and Retreatment of Patients With Primary and Recurrent Endometrial Cancer

Recurrent uterine rupture after hysterescopic resection of the uterine septum

Uterine rupture: the road ahead?

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