Rupture of a myomectomy site in the third trimester of pregnancy after myomectomy, septoplasty and cesarean section: A case report

Abstract

Uterine rupture during pregnancy is a rare but dangerous complication. A history of cesarean section is known to be a risk factor, but other types of uterine surgery can also increase the risk. We report a case of rupture of a myomectomy site in the third trimester of pregnancy without uterine contractions in a woman who had previously undergone myomectomy, septoplasty and cesarean section. The 39-year-old woman (gravida 2, para 2) presented at 29 weeks' gestation with uterine contractions. She was successfully treated with tocolytics. At 32 weeks of pregnancy, in the absence of contractions, the patient complained of severe abdominal pain and she became hypotensive. Emergency laparotomy and cesarean section were performed, resulting in the delivery of a live infant. The myomectomy site was found to have ruptured but the cesarean and septoplasty scars were intact. This case suggests that myomectomy scars are at greater risk of rupture during pregnancy than those resulting from cesarean section and septoplasty.

Systematic review of pregnancy outcomes after fertility-preserving treatment of uterine fibroids

“…Women who undergo myomectomy or UAE seem to be at higher risk during pregnancy as complications with abnormal placentation and a higher risk of the fetus being small for gestational age have been recorded (Pron et al, 2005;Dutton et al, 2007;Marret et al, 2012). Uterine rupture is of further major concern (Hortu et al, 2015;Pakniat et al, 2016;Cho, 2018).…”

Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis

“…Another complication during pregnancy, sometime associated with uterine fibroids, is uterine rupture and placental abnormalities. Only one case of uterine rupture was documented after USgHIFU (0.16%), which is less than the incidence rate of uterine rupture after myomectomy (0.6%) [60] or other uterine surgeries [61,62]. Accordingly, the results of the meta-analysis of 3685 pregnancies after myomectomy found uterine ruptures at a rate of 0.79% [32].…”