Uterine Rupture in Pregnancy following Two Abdominal Myomectomies and IVF

Abstract

Objective. Uterine rupture (UR) during pregnancy is an obstetric emergency that could determine poor maternal and neonatal outcomes. There are many factors that could increase the risk of UR, such as a previous myomectomy. The aim of this study is to evaluate the role of a previous myomectomy in a spontaneous UR in pregnancy. Methods. A 33-year-old primigravida comes to our obstetric emergency room for pelvic pain at 29 weeks of gestation. In her medical history, there were two previous surgical operations of abdominal myomectomy, one in 2015 and one in January 2021 (6 months before conception). After 34 minutes, a pubo-subumbilical longitudinal laparotomy was performed for pathological decelerations in the cardiotocography. In the peritoneal cavity, there was 500 mL of blood serum liquid. The right arm and shoulder of the fetus were extending out of the uterus across a breach of 5 cm near the right tubal corner. A corporal incision was performed, and a healthy baby was born and moved to neonatal intensive unit care. Results. A UR can occur at any stage of pregnancy, mostly during the third trimester of pregnancy. Risk factors that increase the incidence of a uterine rupture after myomectomy include a short period (i.e., <12 months) between the myomectomy and conception, the opening of the endometrial cavity, and large myomas (with a maximum diameter above 4 cm). Uterine rupture during pregnancy after abdominal myomectomy seems to be less frequent than after a laparoscopic one. Conclusion. Uterine rupture is an obstetric emergency; it is mandatory to consider this eventuality in pregnancy, particularly in the third trimester, if there was a previous laparoscopic myomectomy in the anamnesis of the patient.

Silent uterine rupture in the term pregnancy: Three case reports

“…[ 5 ] The most prevalent causes of uterine rupture are widely recognized to include prior laparotomic myomectomy followed by subsequent cesarean section, [ 5 , 6 ] previous cesarean section, [ 7 ] a short interpregnancy interval or brief interval between myomectomy and conception (i.e. <12 months), [ 8 ] abnormal placentation, placenta previa and percreta, [ 9 ] or surgical termination of pregnancy. [ 4 ] Nevertheless, cases of uterine rupture have also been documented in primigravida patients without evident risk factors.…”

“…[ 19 ] Most practitioners recommend elective cesarean delivery if the endometrial cavity is breached, if there is a short interval between surgery and pregnancy, or if there are large myomas (maximum diameter > 4 cm). [ 8 , 20 , 21 ] Therefore, the description of surgical procedures should encompass the crucial elements relevant to subsequent pregnancies. [ 20 ] Obstetricians are cautious in recommending cesarean deliveries to pregnant patients with a history of myomectomy.…”

“…[ 22 ] The subsequent pregnancy rate was higher in individuals undergoing laparoscopic myomectomy than in abdominal myomectomy, [ 23 ] although the incidence of uterine rupture during pregnancy was lower after abdominal myomectomy than after laparoscopic procedures. [ 8 ] Hruban et al [ 5 ] reported a 43-year-old tercigravida with a history of laparotomic myomectomy. In subsequent pregnancy, uterine rupture occurred at the site of the previous uterine scar.…”

Spontaneous cesarean scar dehiscence during pregnancy: A case report and review of the literature

“… 1 , 4 , 13 , 14 Uterine wall thickness less than 2 mm is associated with an increased risk of dehiscence. 1 , 15 Magnetic resonance imaging (MRI) is useful in the work-up of cesarean scar dehiscence and has demonstrated superior accuracy in the evaluation of uterine wall defects. However, it is not an ideal tool for screening purposes as it is expensive and not available like ultrasound.…”

Courses of pregnancy in women witha uterine scar after conservative myomectomy

“…По мнению многих исследователей, женщины, перенесшие консервативную миомэктомию, подвергаются более высокому риску развития таких осложнений во время беременности, как предлежание плаценты, плацентарные нарушения и несостоятельность рубца на матке [10][11][12][13].…”