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Parviz S, Deldar Pasikhani M, KHazardoost S, Malek M, Zamani N. Early diagnosis of impending rupture uterus during U/S: A case report. Int J Surg Case Rep 2024; 119:109741. [PMID: 38762958 PMCID: PMC11111825 DOI: 10.1016/j.ijscr.2024.109741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 05/21/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Uterine rupture is a rare condition that typically occurs in a scarred uterus and can happen during late pregnancy, labor, or the early postpartum period. Since most cases are seen in patients with a history of cesarean surgery, the anterior lower uterine segment is the most affected area. Most patients present with acute symptoms that compromise the fetus and the mother in a life-threatening manner. CASE PRESENTATION We present a case of uterine rupture with subacute symptoms occurring in the second trimester, which is extremely rare. The patient was a stable second-trimester multiparous woman with chronic abdominal pain, but without any signs of peritoneal bleeding or instability. No history of previous cesarean section was present, and she had recently undergone a non-complicated hysteroscopic polypectomy. Transabdominal and transvaginal ultrasounds were performed, revealing a significant full-thickness myometrial defect in the posterior uterine lower segment. This defect allowed the amniotic sac to protrude into the posterior cul-de-sac. No abdominopelvic hematoma was detected. These findings were confirmed in an urgent MRI, and the patient underwent a laparotomy during which a significant full-thickness defect was discovered at the posterior of the uterus. As it was impossible to continue the pregnancy, the fetus was surgically removed and then prepared using multiple layers. CLINICAL DISCUSSION The difference between our case and the previously reported one is in the aspect of gradual stable presentation and lacks of vaginal bleeding. CONCLUSION Previous hysteroscopy carries a risk for future pregnancy complications, such as uterine rupture.
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Affiliation(s)
- Sara Parviz
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Radiology Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Maryam Deldar Pasikhani
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Soghra KHazardoost
- Department of perinatology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahrooz Malek
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Radiology Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Narges Zamani
- Department of Gynecologic Oncology, Vali-Asr Hospital, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran.
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Abstract
Uterine perforation during hysteroscopic operative procedures is a potential complication well known to gynaecologists. Uterine septa are a commonly encountered Müllerian anomaly related to pregnancy loss and infertility. Hysteroscopic resection of septa has shown to improve pregnancy outcome. There are limited case reports of uterine rupture in subsequent pregnancies after hysteroscopic septal resection. Our patient had a hysteroscopic septal resection done a year prior which was complicated by a uterine fundal perforation, left to spontaneously heal after immediate sealing with cautery. The patient conceived spontaneously soon after and underwent an emergency caesarean section for severe pre-eclampsia. Intraoperatively, after removal of the placenta, we discovered a 3 cm symmetrical circular defect at the fundus of the uterus with no myometrium or serosa. The potentially disastrous consequences of this silent uterine rupture were mitigated due to another life-threatening condition which prevented the onset of labour.
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Affiliation(s)
- Amenda Ann Davis
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Zeteroğlu Ş, Aslan M, Akar B, Ada Bender R, Başbuğ A, Çalışkan E. Uterine rupture in pregnancy subsequent to hysteroscopic surgery: A case series. Turk J Obstet Gynecol 2017; 14:252-255. [PMID: 29379670 PMCID: PMC5780571 DOI: 10.4274/tjod.77642] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/12/2017] [Indexed: 12/01/2022] Open
Abstract
Uterine rupture during pregnancy is associated with high mortality and morbidity rates in both the fetus and the mother. Hysteroscopic surgeries such as myomectomy and septum resection are known risk factors for uterine rupture in pregnancy following the operation. We present four infertile patients who were admitted to Kocaeli Medical Park Hospital between February 2014 and November 2016. Three of the patients underwent hysteroscopic septum resection without complication and one had hysteroscopic myomectomy and a 7-8 mm sized rupture was detected. All of the patients became pregnant in less than a year after the operations. The first three patients had uterine rupture at 22nd, 38th, and 10th week, which is the earliest rupture in the literature. The last patient had an uneventful pregnancy and the rupture was observed during cesarean section. A short interval between hysteroscopy and pregnancy may increase the risk of rupture. It may be possible to become pregnant despite rupture and not have any problems during the entire pregnancy.
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Affiliation(s)
- Şahin Zeteroğlu
- Bursa Acıbadem Hospital, Clinic of Obstetrics and Gynecology, Bursa, Turkey.,Acıbadem University, Vocaitonal High School, İstanbul, Turkey
| | - Melisa Aslan
- Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
| | - Bertan Akar
- İstinye University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Rukiye Ada Bender
- İstinye University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Alper Başbuğ
- Düzce University Faculty of Medicine, Department of Obstetrics and Gynecology, Düzce, Turkey
| | - Eray Çalışkan
- Bahçeşehir University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
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Recurrent rupture uterus after hysteroscopic resection of uterine septum: A case report. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2017.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Alanbay İ, Öztürk M, Ulubay M, Keskin U, Karaşahin E. Recurrent large uterine fundal dehiscence during cesarean section after hysteroscopic uterine septum resection with uterine perforation. CASE REPORTS IN PERINATAL MEDICINE 2016. [DOI: 10.1515/crpm-2015-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Septum resection using hysterescopy is safe, rapid and efective, but some late complication of it may be seen as uterine rupture or dehiscence of uterine wall during pregnancy due to myometrial damage. We present a case of recurrent large uterine fundal dehiscence conscecutive to cesarean section in a patient who had previously undergone a uterine septum resection. The patient was a 35-year-old who presented at 39 weeks of gestation (Gravida 2, Parity 1) and was admitted for an elective cesarean section. Her reproductive history included a septum resection which resulted in uterine perforation, and one previous cesarean section in which a large fundal defect was found and repaired. Then the examination had shown an aproximately 5 cm large uterine fundus defect including all three layers of uterus which had been repaired. Perforation or excessively deep incision of uterine fundus during hysteroscopic metroplasty may cause chronic weakness of the uterine wall especially at fundal localization. Our case was an incidental uterine wall dehiscence during cesarean section. Patients with an uterine septum resection history should be followed up carefully for uterine rupture during pregnancy.
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Affiliation(s)
- İbrahim Alanbay
- Gülhane Military Medical Academy, Obstetrics and Gynecology Department, Etlik, Ankara, Turkey
| | - Mustafa Öztürk
- Etimesgut Military Hospital Obstetrics and Gynecology Department, 06180, Etimesgut, Ankara, Turkey
| | - Mustafa Ulubay
- Gülhane Military Medical Academy, Obstetrics and Gynecology Department, Etlik, Ankara, Turkey
| | - Uğur Keskin
- Gülhane Military Medical Academy, Obstetrics and Gynecology Department, Etlik, Ankara, Turkey
| | - Emre Karaşahin
- Gülhane Military Medical Academy, Obstetrics and Gynecology Department, Etlik, Ankara, Turkey
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Abstract
Adverse events associated with hysteroscopic procedures are generally rare, but, with increasing operative complexity, it is now apparent that they are experienced more often. There exists a spectrum of complications that relate to generic components of procedures, such as patient positioning, anesthesia, and analgesia, to a number that are specific to intraluminal endoscopic surgery that largely comprise perforation and injuries to surrounding structures and blood vessels. Whereas a number of endoscopic procedures require the use of distending media, the response of premenopausal women to excessive absorption of nonionic fluids used for hysteroscopy is somewhat unique, and deserves special attention on the part the surgeon. There is also an increasing awareness of uncommon but problematic sequelae related to the use of monopolar radiofrequency uterine resectoscopes that involve thermal injury to the vulva and vagina. Furthermore, the uterus that has previously undergone hysteroscopic surgery may behave in unusual ways, at least in premenopausal women who experience menstruation or who become pregnant. Fortunately, better understanding of the mechanisms involved in these adverse events, as well as the use or development of a number of innovative devices, have collectively provided the opportunity to perform hysteroscopic and resectoscopic surgery in a manner that minimizes risk to the patient.
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Dural O, Yasa C, Bastu E, Ugurlucan FG, Can S, Yilmaz G, Buyru F. Reproductive Outcomes of Hysteroscopic Septoplasty Techniques. JSLS 2016; 19:JSLS.2015.00085. [PMID: 26681911 PMCID: PMC4674815 DOI: 10.4293/jsls.2015.00085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Since little is known regarding the correlation between different techniques used during hysteroscopic septoplasty and reproductives outcomes, we amied to evaluate the results of two different techniques of hysteroscopic septoplasty (HS). Methods: Data were retrospectively reviewed on 49 patients who underwent HS for symptomatic septate uterus from January 1, 2010, through April 30, 2014. The patients were divided into 2 groups based on the HS technique used. Group I consisted of 27 patients who underwent HS by monopolar hook cautery with the operating hysteroscope. Group II consisted of 22 patients who had the procedure performed with scissors and guided by an office hysteroscope. All the procedures in the both groups were performed in the operating room under general anesthesia. Pregnancy outcomes within the first year after HS for both groups were evaluated. Results: Reproductive outcomes were obtained from 44 patients who attempted to conceive after HS within the first year. In the 25 patients in group I, 23 had pregnancies, of which 15 (65.2%) continued to term, 3 (13%) ended in a preterm live birth, and 5 (21.7%) ended in loss of pregnancy (abortion). In the 19 patients in group II, there were 17 pregnancies, of which 11 (64.7%) continued to term, 2 (11.7%) ended in a preterm live birth, and 4 (23.5%) ended in first- or second-trimester abortion. The overall live-birth rate was 78.2% in group I and 76.4% in group II (P = .85). Conclusions: Our data show that the rates of pregnancy that reach term and overall rates of live births are similar between the 2 HS techniques. Additional studies are needed to evaluate the impact of the techniques on reproductive outcomes.
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Affiliation(s)
- Ozlem Dural
- Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Cenk Yasa
- Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Ercan Bastu
- Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Funda Gungor Ugurlucan
- Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Sultan Can
- Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Gamze Yilmaz
- Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Faruk Buyru
- Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
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Masia F, Zoric L, Ripart-Neveu S, Marès P, Ripart J. Spontaneous uterine rupture at 14 weeks gestation during a pregnancy consecutive to an oocyte donation in a woman with Turner's syndrome. Anaesth Crit Care Pain Med 2015; 34:101-3. [DOI: 10.1016/j.accpm.2014.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/18/2014] [Indexed: 11/27/2022]
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Al-Kufaishi A, Erasmus K, Carr D, Owen E. An unusual cause for epigastric pain in pregnancy. Spontaneous uterine rupture with herniation of the amniotic sac in a 33-week primigravida. BMJ Case Rep 2014; 2014:bcr-2013-202973. [PMID: 24599426 DOI: 10.1136/bcr-2013-202973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 29-year-old in vitro fertilisation patient presented at 33 weeks of gestation with abdominal pain. An abdominal ultrasound revealed a cystic lesion adjacent to the fundus. During caesarean section, a defect at the fundus was identified with herniation of the amniotic sac through this defect. There were no complications postoperatively and the patient made an unremarkable recovery. With at least one maternal death reported in the most recent confidential enquiry into maternal death, uterine rupture is an obstetric emergency and can have catastrophic outcomes. The incidence of uterine rupture as a result of previous perforation is unclear with little published data and few case reports. Cases of uterine rupture after perforation following hysteroscopic resection of fibroids, uterine septum are well published but the authors found no known previous cases related to laparoscopy. Counselling patients post perforation should include discussion regarding the management of future pregnancies and the risk of uterine rupture.
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Affiliation(s)
- Asmaa Al-Kufaishi
- Department of Obstetrics and Gynaecology, West Middlesex University Hospital, London, UK
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