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Segal R, Levin I, Many A, Michaan N, Laskov I, Amikam U, Yogev Y, Cohen A. Laparoscopic management of suspected postpartum uterine rupture: a novel approach. J Matern Fetal Neonatal Med 2022; 35:9362-9367. [PMID: 35105254 DOI: 10.1080/14767058.2022.2033721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Exploratory laparotomy is considered the gold standard treatment for women with suspected uterine rupture. We aimed to investigate the feasibility and safety of laparoscopy as an alternative for laparotomy for the management of hemodynamically stable women with suspected postpartum uterine rupture. STUDY DESIGN We conducted a case series study including all women who were diagnosed with postpartum uterine rupture following vaginal delivery in a university-affiliated tertiary hospital, between November 2012 and July 2021. Until 2016, all women with suspected post-partum uterine rupture underwent laparotomy. Following 2016, a new tailored protocol based on laparoscopy for the management of postpartum uterine rupture in hemodynamically stable women was implemented. A comparison was made between women who underwent emergent laparoscopy to laparotomy. RESULTS During the study period 17 women were diagnosed with postpartum uterine rupture. From January 2012 to January 2016, four cases of uterine rupture were diagnosed, all of whom underwent laparotomy. Since 2016, thirteen cases of uterine rupture were diagnosed, of whom seven women (54%) underwent laparoscopy and 6 (46%) laparotomy. The median time interval from delivery to surgery was 70.5 min IQR (40-179) in the laparotomy group and 202 min IQR (70-485) in the laparoscopy group. The median operative time for laparoscopic surgery was 80 min (IQR 60-114) and 78 min (IQR 58-114) for the laparotomy group. Four women who underwent laparotomy (40%) and one who underwent laparoscopy (14.2%) were admitted to the intensive care unit following surgery. Blood products transfusion was required in six women who had laparotomy (60%) and one who had laparoscopy (14.2%). Median hospitalization period was 5 d IQR (4-5) in the laparotomy group as compared to 3 d IQR (3-4) in the laparoscopy group. There were no conversions to laparotomy in the laparoscopy group. CONCLUSIONS In hemodynamic stable women laparoscopic surgery for suspected postpartum uterine rupture is feasible and safe.
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Affiliation(s)
- Roy Segal
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ishai Levin
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Many
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Michaan
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Amikam
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviad Cohen
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Tinelli A, Kosmas IP, Carugno JT, Carp H, Malvasi A, Cohen SB, Laganà AS, Angelini M, Casadio P, Chayo J, Cicinelli E, Gerli S, Palacios Jaraquemada J, Magnarelli G, Medvediev MV, Metello J, Nappi L, Okohue J, Sparic R, Stefanović R, Tzabari A, Vimercati A. Uterine rupture during pregnancy: The URIDA (uterine rupture international data acquisition) study. Int J Gynaecol Obstet 2021; 157:76-84. [PMID: 34197642 DOI: 10.1002/ijgo.13810] [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: 04/05/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To describe the characteristics and peripartum outcomes of patients diagnosed with uterine rupture (UR) by an observational cohort retrospective study on 270 patients. METHODS Demographic information, surgical history, symptoms, and postoperative outcome of women and neonates after UR were collected in a large database. The statistical analysis searched for correlation between UR, previous uterine interventions, fibroids, and the successive perinatal outcomes in women with previous UR. RESULTS Uterine rupture was significantly associated with previous uterine surgery, occurring, on average, at 36 weeks of pregnancy in women also without previous uterine surgery. UR did not rise exponentially with an increasing number of uterine operations. Fibroids were related to UR. The earliest UR occurred at 159 days after hysteroscopic myomectomy, followed by laparoscopic myomectomy (251 days) and laparotomic myomectomy (253 days). Fertility preservation was feasible in several women. Gestational age and birth weight seemed not to be affected in the subsequent pregnancy. CONCLUSION Data analysis showed that previous laparoscopic and abdominal myomectomies were associated with UR in pregnancy, and hysteroscopic myomectomy was associated at earlier gestational ages. UR did not increase exponentially with an increasing number of previous scars. UR should not be considered a contraindication to future pregnancies.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy.,Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, Lecce, Italy.,Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia.,Department of Obstetrics and Gynecology, Veris delli Ponti Hospital, Scorrano & Vito Fazzi Hospital, Lecce, Italy
| | - Ioannis P Kosmas
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia.,Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Hatzikosta, University of Ioannina, Ioannina, Greece
| | - Jose Tony Carugno
- MIGS/Robotics Division Director, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Howard Carp
- Department of Obstetrics and Gynecology, Sheba Medical Center, TLV University, Tel Hashomer, Israel
| | - Antonio Malvasi
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia.,Department of Obstetrics and Gynecology, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Shlomo B Cohen
- Department of Obstetrics and Gynecology, Sheba Medical Center, TLV University, Tel Hashomer, Israel
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Marta Angelini
- Department of Obstetrics and Gynecology, Medical School, University of Udine, Udine, Italy
| | - Paolo Casadio
- Department of Obstetrics and Gynecology, Medical School, University of Bologna, Bologna, Italy
| | - Jenifer Chayo
- Department of Obstetrics and Gynecology, Sheba Medical Center, TLV University, Tel Hashomer, Israel
| | - Ettore Cicinelli
- Department of Obstetrics and Gynecology, Medical School, University of Bari, Bari, Italy
| | - Sandro Gerli
- Department of Obstetrics and Gynecology, Medical School, University of Perugia, Perugia, Italy
| | - Josè Palacios Jaraquemada
- Department of Obstetrics and Gynecology, Medical School, University of Buenos Aires, Buenos Aires, Argentina
| | - Giulia Magnarelli
- Department of Obstetrics and Gynecology, Medical School, University of Bologna, Bologna, Italy
| | - Mykhailo V Medvediev
- Department of Obstetrics and Gynecology, University of Dnepropetrovsk medical academy of Health Ministry of Ukraine, Dnepropetrovsk, Ukraine
| | - Josè Metello
- Centro de Infertilidade e Reprodução Medicamente Assistida, Hospital Garcia de Orta, Almada, Portugal
| | - Luigi Nappi
- Department of Obstetrics and Gynecology, Medical School, University of Foggia, Foggia, Italy
| | - Jude Okohue
- Department of Obstetrics and Gynecology, Madonna University Teaching Hospital, Port Harcourt, Nigeria
| | - Radmila Sparic
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | - Radomir Stefanović
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | - Avinoam Tzabari
- Department of Obstetrics and Gynecology, Hospital Mayane Hayeshua Medical Center, Bnei Brak, Israel
| | - Antonella Vimercati
- Department of Obstetrics and Gynecology, Medical School, University of Bari, Bari, Italy
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4
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Cai YQ, Liu W, Zhang H, He XQ, Zhang J. Laparoscopic repair of uterine rupture following successful second vaginal birth after caesarean delivery: A case report. World J Clin Cases 2020; 8:2855-2861. [PMID: 32742995 PMCID: PMC7360696 DOI: 10.12998/wjcc.v8.i13.2855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/01/2020] [Accepted: 06/17/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND With the increasing trend of vaginal birth after caesarean delivery (VBAC), evaluation of the feasibility and safety of a second VBAC with grand multiparity is worth considering. Intrapartum uterine rupture is diagnosed in approximately one-fifth of all VBAC cases following successful vaginal delivery. To our knowledge, no report is available on the application of laparoscopy to repair postpartum uterine rupture after a successful second VBAC in China.
CASE SUMMARY A 31-year-old woman (gravida 5, para 2) at 39 wk and 5 d of gestation was admitted to the hospital in labour. After a successful VBAC and observation for approximately 13 h, the patient complained of progressive abdominal pain. Given the symptoms, signs, and auxiliary examination results, intraperitoneal bleeding was considered. Because the patient was stable and ultrasound imaging was the only method available to assess the possibility of rupture, we recommended laparoscopy to clarify the diagnosis and for prompt laparoscopic uterine repair or exploratory laparotomy if necessary. Operative findings included transverse uterine scar rupture at the lower uterine segment of approximately 5.0 cm in length and 800 mL of intraoperative pelvic haemoperitoneum. Finally, she successfully underwent laparoscopic repair of uterine rupture and recovered very well according to three-dimensional magnetic resonance imaging at 42 d postpartum.
CONCLUSION Routine postpartum intrauterine exploration is not beneficial to the mother and may even increase the risk of rupture. This case highlights a laparoscopic approach for repairing uterine rupture in the immediate postpartum period.
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Affiliation(s)
- Yan-Qing Cai
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
- Shanghai Municipal Key Clinical Specialty, Shanghai 200030, China
| | - Wei Liu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
- Shanghai Municipal Key Clinical Specialty, Shanghai 200030, China
| | - Hong Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
- Shanghai Municipal Key Clinical Specialty, Shanghai 200030, China
| | - Xiao-Qing He
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
- Shanghai Municipal Key Clinical Specialty, Shanghai 200030, China
| | - Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
- Shanghai Municipal Key Clinical Specialty, Shanghai 200030, China
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