1
|
Grainger TC, McDougall A, Magama Z, Ranawakagedon J, Mallick R, Odejinmi F. Women's experiences of birth and birth options counselling after laparoscopic or open myomectomy. J OBSTET GYNAECOL 2023; 43:2205516. [PMID: 37200382 DOI: 10.1080/01443615.2023.2205516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 04/16/2023] [Indexed: 05/20/2023]
Abstract
There is emerging evidence that vaginal birth after open and laparoscopic myomectomy may be safe in many pregnancies, however, there are no studies examining the perspectives of women who have given birth post myomectomy and their preferences regarding mode of birth. We performed a retrospective questionnaire survey of women who had an open or laparoscopic myomectomy followed by a pregnancy within 3 maternity units in a single NHS trust in the UK over a 5-year period. Our results revealed only 53% felt actively involved in the decision making for their birth plan and 90% had not been offered a specific birth options counselling clinic. Of those who had either a successful trial of labour after myomectomy (TOLAM) or elective caesarean section (ELCS) in the index pregnancy, 95% indicated satisfaction with their mode of birth however, 80% would prefer vaginal birth in a future pregnancy. Whilst long term prospective data is required to fully establish the safety of vaginal birth after laparoscopic and open myomectomy, this study is the first to explore the subjective experiences of women who had given birth post laparoscopic or open myomectomy and has highlighted the inadequate involvement of these women in the decision-making process.IMPACT STATEMENTWhat is already known on this subject? Fibroids are the commonest female solid tumours in women of childbearing age with surgical management including open and laparoscopic excision techniques. However, the management of a subsequent pregnancy and birth remains controversial with no robust guidance on which women may be suitable for vaginal birth.What do the results of this study add? We present the first study to our knowledge which explores women's experiences of birth and birth options counselling after open and laparoscopic myomectomy.What are the implications of these findings for clinical practice and/or further research? We provide a rationale for using birth options clinics to facilitate an informed decision-making process and highlight the current inadequate guidance for clinicians on how to advise women having a pregnancy following a myomectomy. Whilst long term prospective data is required to fully establish the safety of vaginal birth after laparoscopic and open myomectomy, this needs to be carried out in a way which promotes the preferences of the women affected by this research.
Collapse
Affiliation(s)
- Thomas C Grainger
- The Women's Centre, Division of Women's and Children's Health, Whipps Cross University Hospital, Barts Health NHS Trust London, London, UK
| | - Anna McDougall
- The Women's Centre, Division of Women's and Children's Health, Whipps Cross University Hospital, Barts Health NHS Trust London, London, UK
| | - Zwelihle Magama
- The Women's Centre, Division of Women's and Children's Health, Whipps Cross University Hospital, Barts Health NHS Trust London, London, UK
| | - Jeewantha Ranawakagedon
- The Women's Centre, Division of Women's and Children's Health, Whipps Cross University Hospital, Barts Health NHS Trust London, London, UK
| | - Rebecca Mallick
- The Women's Centre, Division of Women's and Children's Health, Whipps Cross University Hospital, Barts Health NHS Trust London, London, UK
| | - Funlayo Odejinmi
- The Women's Centre, Division of Women's and Children's Health, Whipps Cross University Hospital, Barts Health NHS Trust London, London, UK
| |
Collapse
|
2
|
McDougall AA, Strong SM, Wonnacott A, Morin A, Tang LYO, Mallick R, Odejinmi F. Towards a clinical consensus on the management of pregnancy and birth after laparoscopic and open myomectomy: A survey of obstetricians and gynaecologists. Eur J Obstet Gynecol Reprod Biol 2023; 284:82-93. [PMID: 36944305 DOI: 10.1016/j.ejogrb.2023.03.008] [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: 11/06/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES The primary aim was to assess if a clinical consensus regarding the management of pregnancy post myomectomy existed amongst consultant obstetricians and gynaecologists. Secondary objectives were to evaluate factors which influence the clinician's decision making in this group of women. STUDY DESIGN Electronic survey sent to all consultants working in the North Central and East London deanery, Kent Surrey and Sussex deanery and Imperial NHS Trust to assess opinions on mode of birth post myomectomy, intervals advised to pregnancy post myomectomy, factors influencing the management of delivery in the scarred uterus post myomectomy, opinions on induction of labour and questions relating to operative notes. RESULTS 209 consultant responses received between 07/03/2022-07/05/2022 (44% response rate); 77% (161/209) practicing obstetricians and gynaecologists, 10% (21/109) pure gynaecologists and 13% (27/209) pure obstetricians. The majority would support a vaginal birth after open myomectomy (75%) and laparoscopic myomectomy (79%). No consensus was found as to the optimal time interval between myomectomy and pregnancy. Higher frequency of performing myomectomy and a greater level of experience were significantly associated with a shorter interval to pregnancy advised. The most important operative factors influencing decision to support trial of labour post myomectomy were breach of uterine cavity; location of fibroids removed and number of incisions on the uterus. 77% believe women should be given a choice regarding mode of delivery post myomectomy in a similar way to previous LSCS. 82.8% would support enrolment of patients into a prospective trial to investigate delivery post myomectomy. CONCLUSIONS We present a comprehensive survey of clinician opinions on pregnancy post myomectomy demonstrating that the majority of consultant obstetricians and gynaecologists sampled would support vaginal birth post myomectomy; counselling patients in a similar way to VBAC; a standardised myomectomy operation note and enrolment of patients in a future prospective trial. Wide variation in opinion regarding interval to pregnancy post myomectomy has been highlighted. We believe this information will facilitate counselling discussions and empower women with subsequent pregnancies after myomectomy to make an informed decision on mode of birth post myomectomy.
Collapse
Affiliation(s)
- A A McDougall
- Homerton University Hospital, Homerton Row, London E9 6SR, United Kingdom.
| | - S M Strong
- Whipps Cross University Hospital, Whipps Cross Road, London E11 1NR, United Kingdom
| | - A Wonnacott
- Royal London Hospital, Whitechapel Road, London E1 1FR, United Kingdom
| | - A Morin
- Whipps Cross University Hospital, Whipps Cross Road, London E11 1NR, United Kingdom
| | - L Y O Tang
- Royal Free Hospital, Pond St, London NW3 2QG, United Kingdom
| | - R Mallick
- University Hospitals Sussex NHS Foundation Trust, Princess Royal Hospital, Haywards Heath, RH16 4EX, United Kingdom
| | - F Odejinmi
- Whipps Cross University Hospital, Whipps Cross Road, London E11 1NR, United Kingdom
| |
Collapse
|
3
|
Agarwal S, D'Souza R, Dy J. Induction of labour in patients with prior caesarean births or uterine surgery. Best Pract Res Clin Obstet Gynaecol 2021; 79:95-106. [PMID: 35012884 DOI: 10.1016/j.bpobgyn.2021.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/02/2022]
Abstract
The current evidence favours trial of labour after one caesarean in the absence of any other contraindications, recognizing that risks with both trial of labour after caesarean (TOLAC) and elective repeat caesarean section (ERCS) birth are relatively uncommon. When the need for induction of labour (IOL) following a previous caesarean arises, shared decision-making should be based on the current available evidence. This approach, however, needs to be tailored, taking into account the individual's history, initial examination and response to the ongoing process of induction to optimize the maternal and foetal outcomes. This paper aims to review the evidence and provide guidance on decision making surrounding labour induction in a pregnancy following a prior caesarean or uterine surgery.
Collapse
Affiliation(s)
- Sugandha Agarwal
- Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, K1H8L6, ON, Canada.
| | - Rohan D'Souza
- Department of Obstetrics and Gynecology, McMaster University, 501 Smyth Road, Ottawa, K1H8L6, ON, Canada.
| | - Jessica Dy
- Department of Obstetrics and Gynecology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H8L6, Canada.
| |
Collapse
|
4
|
Haviv E, Schwarzman P, Bernstein EH, Wainstock T, Weintraub AY, Leron E, Erez O. Subsequent pregnancy outcomes after abdominal vs. laparoscopic myomectomy. J Matern Fetal Neonatal Med 2021; 35:8219-8225. [PMID: 34404312 DOI: 10.1080/14767058.2021.1967315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine whether abdominal (open) vs. laparoscopic myomectomy affects the obstetrical outcomes of subsequent pregnancies. METHODS A retrospective cohort study was conducted at a tertiary university medical center. The study population included women who had a documented birth following a myomectomy at our institution between the years 1997 and 2018. The obstetrical characteristics and immediate perinatal outcomes of the subsequent pregnancy following open vs. laparoscopic myomectomy were collected and compared. Data were retrieved from patients' medical records via the institutional computerized database. Cases that lacked detailed surgery and delivery reports were excluded. Data were analyzed using a chi-square test for categorical variables and one-way ANOVA for continuous variables. A p-value <.05 was considered statistically significant. RESULTS During the study period, 57 women met the inclusion criteria, of whom 66.6% (38/57) had an open and 33.3% (19/57) had a laparoscopic myomectomy. Women who underwent an open myomectomy had a higher rate of cesarean birth than those in the laparoscopic group (89.5 vs. 42.1%, p < .001). No cases of severe maternal or perinatal complications, uterine ruptures, or placental abruptions were identified in either study group. No other significant differences were noted between the two types of myomectomy. CONCLUSION Open myomectomy is associated with a higher rate of cesarean delivery than laparoscopic. No severe adverse maternal or neonatal outcomes were detected in either study group.
Collapse
Affiliation(s)
- Elihai Haviv
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eli H Bernstein
- The Medical School for International Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Elad Leron
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Offer Erez
- Division of Obstetrics & Gynecology, Maternity Department "D", Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, USA
| |
Collapse
|
5
|
Gambacorti-Passerini ZM, Penati C, Carli A, Accordino F, Ferrari L, Berghella V, Locatelli A. Vaginal birth after prior myomectomy. Eur J Obstet Gynecol Reprod Biol 2018; 231:198-203. [PMID: 30396109 DOI: 10.1016/j.ejogrb.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this retrospective cohort study was to evaluate the obstetrical and perinatal outcomes of vaginal birth in case of pregnancies achieved after prior myomectomy. We also analyzed how operative characteristics at the time of surgery might influence the choice of obstetricians about mode of delivery. STUDY DESIGN We analyzed retrospectively all women who underwent laparoscopic (LPS) or laparotomic (LPT) myomectomy between January 2002 and December 2014, in a network of three Institutions belonging to the University of Milano Bicocca, Italy. Women were contacted by phone interview and only cases with available follow-up data and who had a subsequent pregnancy were included. Operative characteristics and subsequent obstetrical outcomes were recorded and analyzed. RESULTS 469 women who underwent myomectomy were contacted by phone interview, and 152 pregnancies were achieved after surgery, 96 after LPS and 56 after LPT. A total of 110 pregnancies ended in deliveries at ≥24 weeks. Seventy-three (66.4%) women had trial of labor after myomectomy (TOLAM), while 24 (21.8%) had a planned cesarean delivery (CD). Sixty-six (90.4%) of the TOLAM cases successfully accomplished vaginal delivery. No cases of uterine rupture (UR) were reported, and all deliveries ended in live births. The incidence of Neonatal Intensive Care Unit admission was 14.5% (16/110), with no cases of perinatal death. Comparing the surgical details at the time of myomectomy, the incidence of uterine cavity entered was significantly higher in planned CD group compared to TOLAM cases (p < 0.001). No other significant difference between the two groups was reported. CONCLUSIONS A successful vaginal delivery was accomplished by 90.4% of women who had TOLAM, without any case of UR or severe maternal and perinatal complications. TOLAM may be considered and offered as feasible and relatively safe option. Obstetricians' attitude toward mode of delivery after prior myomectomy seems to be influenced by the reported entry into the uterine cavity at the time of surgery.
Collapse
Affiliation(s)
| | - C Penati
- Department of Obstetrics and Gynecology, Carate Brianza Hospital, ASST Vimercate, Italy
| | - A Carli
- University of Milano Bicocca, Milan, Italy; Department of Obstetrics and Gynecology, San Gerardo Hospital - FMBBM, Monza, Italy
| | - F Accordino
- University of Milano Bicocca, Milan, Italy; Department of Obstetrics and Gynecology, San Gerardo Hospital - FMBBM, Monza, Italy
| | - L Ferrari
- Department of Obstetrics and Gynecology, San Gerardo Hospital, ASST Monza, Italy
| | - V Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States
| | - A Locatelli
- University of Milano Bicocca, Milan, Italy; Department of Obstetrics and Gynecology, Carate Brianza Hospital, ASST Vimercate, Italy
| |
Collapse
|
6
|
Wu X, Jiang W, Xu H, Ye X, Xu C. Characteristics of uterine rupture after laparoscopic surgery of the uterus: clinical analysis of 10 cases and literature review. J Int Med Res 2018; 46:3630-3639. [PMID: 29916299 PMCID: PMC6136024 DOI: 10.1177/0300060518776769] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective An increasing trend of uterine rupture (UR) after laparoscopic surgery of the
uterus (LSU) has been observed. Although the overall incidence is extremely
low, UR may have catastrophic outcomes. Therefore, investigation of its
potential risk factors is important. Methods We retrospectively reviewed the medical data of 10 women who developed UR
after LSU performed at our hospital from October 2003 to October 2016 and
conducted a literature review. Results All cases of UR occurred during the third trimester of pregnancy. The
surgeries contributing to UR were laparoscopic myomectomy, adhesion
decomposition, and salpingectomy, resulting in unfavorable outcomes
especially for the fetus. Diathermy was routinely used for hemostasis, and
multilayer suturing was not adequately performed in many cases. The
posterior wall was the most common site of UR in most cases. Silent rupture
with unremarkable symptoms was not rare. Similar risk factors were
identified in the literature review. Conclusions Excessive use of energy equipment and the lack of multilayer suturing were
the most common characteristics of UR after LSU. A history of LSU should
always be considered a risk factor for UR.
Collapse
Affiliation(s)
- Xiaoyi Wu
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Wei Jiang
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Huan Xu
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Xuping Ye
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Congjian Xu
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China.,2 Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai 200032, People's Republic of China.,3 Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, People's Republic of China
| |
Collapse
|
7
|
Pop L, Suciu ID, Oprescu D, Micu R, Stoicescu S, Foroughi E, Sipos P. Patency of uterine wall in pregnancies following assisted and spontaneous conception with antecedent laparoscopic and abdominal myomectomies - a difficult case and systematic review. J Matern Fetal Neonatal Med 2018; 32:2241-2248. [PMID: 29320920 DOI: 10.1080/14767058.2018.1427060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A case of uterine rupture at 24 weeks in a pregnancy succeeding myomectomy and triple embryo transfer is described and literature is reviewed systematically to evaluate the importance of uterine rupture in pregnancies after myomectomy in general and some important sub-populations. Systematic search identified 179 papers and following a strategical selection process 45 studies were analyzed in detail, including 6 cohort and 19 observational studies, 3 case series and 17 case reports. Comparison of risk of uterine rupture after abdominal and laparoscopic myomectomy is made. In pregnancies after IVF number of embryos transferred are determined. Optimal contraceptive intervals and surgical techniques are discussed. The consequences of these observations are analyzed and conclusions are made which can assist individualizing treatment options and improve patient selection.
Collapse
Affiliation(s)
- Lucian Pop
- a Department of Obstetrics and Gynecology , Alessandrescu-Rusescu Institute of Mother and Child Care , Bucharest , Romania.,b Department of Obstetrics and Gynecology , University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
| | - Ioan Dumitru Suciu
- c Department of General Surgery , Floreasca Emergency Hospital , Bucharest , Romania
| | - Daniela Oprescu
- a Department of Obstetrics and Gynecology , Alessandrescu-Rusescu Institute of Mother and Child Care , Bucharest , Romania.,b Department of Obstetrics and Gynecology , University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
| | - Romeo Micu
- d Department of Mother and Child , Iuliu Hateganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Silvia Stoicescu
- a Department of Obstetrics and Gynecology , Alessandrescu-Rusescu Institute of Mother and Child Care , Bucharest , Romania.,b Department of Obstetrics and Gynecology , University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
| | - Ebrahim Foroughi
- e Department of Obstetrics and Gynaecology , Sheffield Teaching Hospitals , Sheffield , UK
| | - Peter Sipos
- e Department of Obstetrics and Gynaecology , Sheffield Teaching Hospitals , Sheffield , UK.,f Department of Oncology and Metabolism , University of Sheffield , Sheffield , UK
| |
Collapse
|
8
|
Serrano Diana C, Díaz Serrano MD, Arenas Gomez B, Gómez García MT, Martinez Carrasco AM, Amezcua Recover AN, Gonzalez de Merlo G. Spontaneous uterine rupture at 19 weeks of gestation. Eur J Obstet Gynecol Reprod Biol 2017; 217:183-184. [PMID: 28911796 DOI: 10.1016/j.ejogrb.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Affiliation(s)
- C Serrano Diana
- Department of Obstetrics and Gynecology, University General Hospital of Albacete, School of Medicine of Albacete, Spain.
| | - M D Díaz Serrano
- Department of Obstetrics and Gynecology, University General Hospital of Albacete, School of Medicine of Albacete, Spain
| | - B Arenas Gomez
- Department of Obstetrics and Gynecology, University General Hospital of Albacete, School of Medicine of Albacete, Spain
| | - M T Gómez García
- Department of Obstetrics and Gynecology, University General Hospital of Albacete, School of Medicine of Albacete, Spain; Department of Medical Sciences, School of Medicine of Albacete, University of Castilla-La Mancha, Spain
| | - A M Martinez Carrasco
- Department of Obstetrics and Gynecology, University General Hospital of Albacete, School of Medicine of Albacete, Spain
| | - A N Amezcua Recover
- Department of Obstetrics and Gynecology, University General Hospital of Albacete, School of Medicine of Albacete, Spain; Department of Medical Sciences, School of Medicine of Albacete, University of Castilla-La Mancha, Spain
| | - G Gonzalez de Merlo
- Department of Obstetrics and Gynecology, University General Hospital of Albacete, School of Medicine of Albacete, Spain; Department of Medical Sciences, School of Medicine of Albacete, University of Castilla-La Mancha, Spain
| |
Collapse
|
9
|
Laparoscopy or laparotomy as the way of entrance in myoma enucleation. Arch Gynecol Obstet 2017; 296:709-720. [PMID: 28819682 DOI: 10.1007/s00404-017-4490-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/07/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Uterine myomas are the main cause of benign uterine diseases in premenopausal women. Objective of the present paper is to investigate the current best treatment modalities of myomas, depending on age of the patient and her desire to preserve fertility, as well as on clinical presentation of this pathology, such as size, number, and location of fibroids and, furthermore, on surgical experience of the gynecologist. METHODS The design of our work is a systematic literature review of existing studies, reviews, and meta-analysis conducted in PubMed and Cochrane Library to identify relevant literature. Commonly, the myomectomy is to be recommended in women desiring to preserve fertility when myomas are associated with symptoms such as excessive bleeding, pelvic discomfort, or palpable abdominally fibroids. The decision of surgical approach for myomectomy should be individualized, depending on size and location, as well as on surgeon's experience. The different modalities of myomectomy, laparoscopic, hysteroscopic, robotic-assisted, or laparotomic are in detail presented in the paper, according to Society of Obstetricians and Gynecologists of Canada (SOGC) clinical practice guidelines and taking into consideration possible concerns of myomectomy such as uterine rupture, development of adhesions, and myomas' recurrence.
Collapse
|
10
|
Huang YT, Yim SLY, Kapurubandara S, Anpalagan A. Antepartum uterine rupture at 29 weeks gestation following unilateral salpingectomy and review of literature. BMJ Case Rep 2017; 2017:bcr-2015-211359. [PMID: 28298378 DOI: 10.1136/bcr-2015-211359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Antepartum uterine rupture following salpingectomy is a rare condition and is associated with high fetal and maternal mortality and morbidity. We illustrate a 33-year-old primigravida who presented with abdominal pain at 29 weeks of gestation. Her previous obstetric history included a ruptured right ectopic pregnancy for which she underwent laparoscopic salpingectomy with no breach of uterine cavity. Her antenatal care had otherwise been unremarkable. Following admission for undetectable fetal heart, ultrasound and CT demonstrated an extrauterine fetus at the right adnexal region with free fluid consistent with intra-abdominal haemorrhage. An exploratory laparotomy was performed which revealed a uterine rupture at the right cornua with the extruded fetus en caul. The fetus was delivered and the uterus repaired in three layers. The patient made an uneventful postoperative recovery and was discharged 5 days following surgery. We review the current literature including the evaluation and management of this rare condition.
Collapse
Affiliation(s)
- Yu-Ting Huang
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Stephen Li-Yen Yim
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Supuni Kapurubandara
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Anbu Anpalagan
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
11
|
Kabra SL, Laul P, Godha Z, Kadam VK. Case Series: Spontaneous Rupture of Uterus in Early Pregnancy. J Obstet Gynaecol India 2016; 66:710-713. [PMID: 27803551 PMCID: PMC5080246 DOI: 10.1007/s13224-015-0834-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Shashi Lata Kabra
- Department of Obstetrics and Gynaecology, Deen Dayal Upadhaya Hospital, New Delhi, India
| | - Poonam Laul
- Department of Obstetrics and Gynaecology, Deen Dayal Upadhaya Hospital, New Delhi, India
| | - Zeepee Godha
- Department of Obstetrics and Gynaecology, Deen Dayal Upadhaya Hospital, New Delhi, India
| | - V. K. Kadam
- Department of Obstetrics and Gynaecology, Deen Dayal Upadhaya Hospital, New Delhi, India
| |
Collapse
|
12
|
Gambacorti-Passerini Z, Gimovsky AC, Locatelli A, Berghella V. Trial of labor after myomectomy and uterine rupture: a systematic review. Acta Obstet Gynecol Scand 2016; 95:724-34. [DOI: 10.1111/aogs.12920] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 05/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Alexis C. Gimovsky
- Division of Maternal Fetal Medicine; Department of Obstetrics and Gynecology; Sidney Kimmel College of Medicine; Thomas Jefferson University; Philadelphia PA USA
| | - Anna Locatelli
- Department of Obstetrics and Gynecology; University of Milan Bicocca; Milan Italy
| | - Vincenzo Berghella
- Division of Maternal Fetal Medicine; Department of Obstetrics and Gynecology; Sidney Kimmel College of Medicine; Thomas Jefferson University; Philadelphia PA USA
| |
Collapse
|
13
|
Après myomectomie, les patientes ont-elles le droit d’accoucher par voie basse ? Résultats d’une étude monocentrique. ACTA ACUST UNITED AC 2015; 43:496-501. [DOI: 10.1016/j.gyobfe.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/13/2015] [Indexed: 11/20/2022]
|
14
|
Sangha R, Strickler R, Dahlman M, Havstad S, Wegienka G. Myomectomy to Conserve Fertility: Seven-Year Follow-Up. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:46-51. [DOI: 10.1016/s1701-2163(15)30362-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|