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Deshmukh U, Denoble AE, Son M. Trial of labor after cesarean, vaginal birth after cesarean, and the risk of uterine rupture: an expert review. Am J Obstet Gynecol 2024; 230:S783-S803. [PMID: 38462257 DOI: 10.1016/j.ajog.2022.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 03/12/2024]
Abstract
The decision to pursue a trial of labor after cesarean delivery is complex and depends on patient preference, the likelihood of successful vaginal birth after cesarean delivery, assessment of the risks vs benefits of trial of labor after cesarean delivery, and available resources to support safe trial of labor after cesarean delivery at the planned birthing center. The most feared complication of trial of labor after cesarean delivery is uterine rupture, which can have catastrophic consequences, including substantial maternal and perinatal morbidity and mortality. Although the absolute risk of uterine rupture is low, several clinical, historical, obstetrical, and intrapartum factors have been associated with increased risk. It is therefore critical for clinicians managing patients during trial of labor after cesarean delivery to be aware of these risk factors to appropriately select candidates for trial of labor after cesarean delivery and maximize the safety and benefits while minimizing the risks. Caution is advised when considering labor augmentation and induction in patients with a previous cesarean delivery. With established hospital safety protocols that dictate close maternal and fetal monitoring, avoidance of prostaglandins, and careful titration of oxytocin infusion when induction agents are needed, spontaneous and induced trial of labor after cesarean delivery are safe and should be offered to most patients with 1 previous low transverse, low vertical, or unknown uterine incision after appropriate evaluation, counseling, planning, and shared decision-making. Future research should focus on clarifying true risk factors and identifying the optimal approach to intrapartum and induction management, tools for antenatal prediction, and strategies for prevention of uterine rupture during trial of labor after cesarean delivery. A better understanding will facilitate patient counseling, support efforts to improve trial of labor after cesarean delivery and vaginal birth after cesarean delivery rates, and reduce the morbidity and mortality associated with uterine rupture during trial of labor after cesarean delivery.
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Affiliation(s)
- Uma Deshmukh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
| | - Annalies E Denoble
- Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT
| | - Moeun Son
- Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT.
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2
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Yao F, Gao H, Wang L, Chen O, Yang X, Xu Q, Zhao M. Successful management of cornual heterotopic pregnancy. Taiwan J Obstet Gynecol 2024; 63:135-136. [PMID: 38216259 DOI: 10.1016/j.tjog.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 01/14/2024] Open
Affiliation(s)
- FengXiang Yao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - HaiXia Gao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - LinLin Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - OuJing Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Xue Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China.
| | - QinYan Xu
- Department of Obstetrics and Gynecology, The 906th Hospital of PLA, Ningbo, Zhejiang, China
| | - Min Zhao
- Department of Obstetrics and Gynecology, The 906th Hospital of PLA, Ningbo, Zhejiang, China
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3
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Li YL, Chuang FC, Lan KC. Reply to "Successful management of cornual heterotopic pregnancy". Taiwan J Obstet Gynecol 2024; 63:131. [PMID: 38216256 DOI: 10.1016/j.tjog.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 01/14/2024] Open
Affiliation(s)
- Yi-Ling Li
- Department of Obstetrics and Gynecology, Jen Ai Hospital, Taichung 412, Taiwan; Department of Obstetrics and Gynecology, Chang Chung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Fei-Chi Chuang
- Department of Obstetrics and Gynecology, Chang Chung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Kuo-Chung Lan
- Department of Obstetrics and Gynecology, Jen Ai Hospital, Taichung 412, Taiwan; Department of Obstetrics and Gynecology, Chang Chung Memorial Hospital, Kaohsiung 833, Taiwan.
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4
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Perdue M, Felder L, Berghella V. First-trimester uterine rupture: a case report and systematic review of the literature. Am J Obstet Gynecol 2022; 227:209-217. [PMID: 35487324 DOI: 10.1016/j.ajog.2022.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to present a case of first-trimester uterine rupture and perform a systematic review to identify common presentations, risk factors, and management strategies. DATA SOURCES Searches were performed in PubMed, Ovid, and Scopus using a combination of key words related to "uterine rupture," "first trimester," and "early pregnancy" from database inception to September 30, 2020. STUDY ELIGIBILITY CRITERIA English language descriptions of uterine rupture at ≤14 weeks of gestation were included, and cases involving pregnancy termination and ectopic pregnancy were excluded. METHODS Outcomes for the systematic review included maternal demographics, description of uterine rupture, and specifics of uterine rupture diagnosis and management. Data were extracted to custom-made reporting forms. Median values were calculated for continuous variables, and percentages were calculated for categorical variables. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist for case reports and case series. RESULTS Overall, 61 cases of first-trimester uterine rupture were identified, including our novel case. First-trimester uterine ruptures occurred at a median gestation of 11 weeks. Most patients (59/61 [97%]) had abdominal pain as a presenting symptom, and previous uterine surgery was prevalent (44/61 [62%]), usually low transverse cesarean delivery (32/61 [52%]). The diagnosis of uterine rupture was generally made after surgical exploration (37/61 [61%]), with rupture noted in the fundus in 26 of 61 cases (43%) and in the lower segment in 27 of 61 cases (44%). Primary repair of the defect was possible in 40 of 61 cases (66%), whereas hysterectomy was performed in 18 of 61 cases (30%). Continuing pregnancy was possible in 4 of 61 cases (7%). CONCLUSION Uterine rupture is an uncommon occurrence but should be considered in patients with an acute abdomen in early pregnancy, especially in women with previous uterine surgery. Surgical exploration is typically needed to confirm the diagnosis and for management. Hysterectomy is not always necessary; primary uterine repair is sufficient in more than two-thirds of the cases to achieve hemostasis. Continuing pregnancy, although uncommon, is also possible.
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Affiliation(s)
- Makenzie Perdue
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Laura Felder
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
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5
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Tang S, Du T, Huang J, Ye H, Zhao M, Lin J, Kuang Y. Effect of previous wedge resection for interstitial pregnancy on pregnancy and neonatal outcomes following frozen-thawed embryo transfer (FET) cycles of IVF/ICSI: a retrospective study. Reprod Biol Endocrinol 2022; 20:23. [PMID: 35105356 PMCID: PMC8805226 DOI: 10.1186/s12958-022-00896-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The present study aimed to evaluate pregnancy and neonatal outcomes in women, with a previous history of wedge resection for interstitial pregnancy, in frozen-thawed embryo transfer (FET) cycles of IVF/ICSI. METHODS The present study involved a retrospective case-control assessment of 75 cases and 375 control subjects over 6 years in a single center. To compare pregnancy and neonatal outcomes between cases, treated using wedge resection, and controls without any previous history of ectopic pregnancy, propensity score matching (1:5) was utilized. The study also compared subgroups in the case group. RESULTS Women with previous wedge resection exhibited higher rates of ectopic pregnancy and uterine rupture rate as compared to control subjects (9.1% vs 1.3%, P = 0.025 and 4.5% vs 0%, P = 0.035, respectively). No statistically significant differences were recorded between the two cohorts with regard to clinical pregnancy rate, live birth rate, and neonatal outcomes. For pregnancy type subgroup analysis, Z-score and rates of large for gestational age were recorded to be significantly lower in twin pregnancy subgroup when compared with singleton pregnancy subgroup (0.10 (- 0.59, 0.25) vs 0.50 (- 0.97, 1.39), P = 0.005; 4.5% vs 26.1%, P = 0.047, respectively). CONCLUSION The results of the present study indicated that previous wedge resection correlated to a higher risk of ectopic pregnancy and uterine rupture. However, it might not be related to an increased risk of adverse neonatal outcomes. The study recommended cesarean section in these patients. Further studies are required to verify the validity of current recommendations.
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Affiliation(s)
- Shengluan Tang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Tong Du
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Jialyu Huang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Hongjuan Ye
- Department of Reproductive Medicine Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ming Zhao
- Shanghai Towako Hospital, No. 477, Fute West 1st Road, Shanghai, China
| | - Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
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Management of interstitial pregnancy in the era of laparoscopy: a meta-analysis of 855 case studies compared with traditional techniques. Obstet Gynecol Sci 2021; 64:156-173. [PMID: 33539687 PMCID: PMC7990998 DOI: 10.5468/ogs.20299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/27/2020] [Indexed: 11/08/2022] Open
Abstract
Interstitial pregnancy is a rare, life-threatening condition that requires high clinical suspicion for diagnosis. Most cases are discovered after complications have occurred. Many authors have described laparoscopic management. Although previous systematic reviews have compared the attributes and complications associated with interstitial pregnancy, we endeavored to complete the first systematic review and meta-analysis to compare the laparoscopic treatment of interstitial pregnancy with the open approach in the modern age of laparoscopic surgery. We systematically searched PubMed, ClinicalTrials.gov, Scopus, Web of Science, and Cochrane until June 2020 using relevant keywords and screened them for eligibility. We found a statistically significant difference in blood loss between laparoscopic and open surgery (168 mL compared to 1,163 mL). Further, cumulative meta-analysis has revealed that blood loss in laparoscopy has been decreasing over time from 1991 to 2020. Laparoscopic patients took less operative time (63.2 minutes) compared to laparotomy patients (78.2 minutes). Patients in the laparoscopic group spent less time hospitalized (3.7 days) compared to laparotomy patients (5.2 days). Our findings add strength to the position that laparoscopic approaches to interstitial pregnancy can be considered first-line in most situations. The laparoscopic approach was found to have a mean blood loss of 168 mL, and this blood loss seems to decrease over time. Increased gravidity and duration of amenorrhea are positive factors that increase bleeding during the procedure. We are unable to find enough high-quality data to significantly compare successful pregnancy following surgery or risk of mortality in these populations.
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7
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Yao F, Jin B. Letter to "Spontaneous unscarred uterine rupture and surgical repair at 11 weeks of gestation in a twin pregnancy". J Obstet Gynaecol Res 2020; 46:2702. [PMID: 33006266 DOI: 10.1111/jog.14515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- FengXiang Yao
- Department of Obstetrics and Gynecology, Ningbo First Hospital, Ningbo, China
| | - BoHong Jin
- Department of Obstetrics and Gynecology, Ningbo First Hospital, Ningbo, China
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8
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Takahashi T, Ota K, Jimbo M, Mizunuma H. Spontaneous unscarred uterine rupture and surgical repair at 11 weeks of gestation in a twin pregnancy. J Obstet Gynaecol Res 2020; 46:1911-1915. [PMID: 32643254 DOI: 10.1111/jog.14396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/20/2020] [Accepted: 06/19/2020] [Indexed: 12/01/2022]
Abstract
A uterine rupture may result in a massive hemoperitoneum, which can be fatal to both the fetus and mother. Most uterine ruptures during pregnancy occur within a scarred uterus, rarely occurring in an unscarred uterus. Here, we report a very rare case of spontaneous rupture in an unscarred uterus at 11 weeks of gestation of a twin pregnancy and its surgical repair. A 37-year-old nulliparous infertile woman became pregnant with twins after artificial insemination and gonadotropin therapy. She underwent emergency surgery at 11 weeks of gestation due to an acute abdomen caused by massive hemoperitoneum. Upon laparotomy, one fetus with placenta was extruded into the abdominal cavity through a 3-cm myometrium rupture on the left posterior wall of the uterus. After surgical repair of the rupture site, the remaining fetus was alive and was successfully delivered by cesarean section at 34 weeks of gestation.
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Affiliation(s)
- Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Kuniaki Ota
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Masatoshi Jimbo
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Hideki Mizunuma
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
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9
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First Trimester Uterine Rupture: A Case Report and Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082976. [PMID: 32344763 PMCID: PMC7215710 DOI: 10.3390/ijerph17082976] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 11/17/2022]
Abstract
The aim is to report a case of spontaneous uterine rupture in the first trimester of pregnancy and to review the literature on the topic. METHODS A literature search was performed using PubMed and Scopus. Relevant English articles were identified without any time or study limitations. The data were aggregated, and a summary statistic was calculated. RESULTS A 35-year-old gravida 5, para 2 was admitted at our department because of fainting and abdominal pain. The woman had a first-trimester twin pregnancy and a history of two previous cesarean sections (CSs). Suspecting a uterine rupture, an emergency laparotomy was performed. The two sacs were completely removed, and the uterine rupture site was closed with a double-layer suture. The patient was discharged from hospital four days later in good condition. On the basis of this experience, a total of 76 case reports were extracted from PubMed and included in the review. Fifty-three patients out of 76 (69.74%) underwent previous surgery on the uterus. Most women (67.92%) had a CS, and in this group a cesarean scar pregnancy (CSP) or a placenta accreta spectrum (PAS) disorder was found to be the etiology in 77.78% of cases. Furthermore, 35.85% of the women had hysterectomy after uterine rupture. Twenty-three patients out of 76 (30.26%) had an unscarred uterus. Of this group, most women presented a uterine anomaly (43.48%). Moreover, 17.39% of these women had a hysterectomy. CONCLUSION According to the literature, the current pandemic use of CS explains most cases of first-trimester uterine rupture.
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10
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Hua Z, Wu M. Spontaneous rupture of the uterus following salpingectomy: a case report and literature review. J Int Med Res 2019; 47:5328-5336. [PMID: 31554449 PMCID: PMC6833417 DOI: 10.1177/0300060519874903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Laparoscopic salpingectomy (LPSC) is the main treatment for ectopic pregnancy, which leads to spontaneous uterine rupture (UR) during pregnancy. We report the characteristics of a woman who had spontaneous UR during pregnancy with a history of salpingectomy. We experienced a 31-year-old woman with a UR in pregnancy with a history of LPSC twice. The patient had a successful pregnancy. We also performed a literature review including cases with spontaneous UR after LPSC. Twenty-seven case reports of 48 women were included in our review. Thirty-five (83.33%, 35/42) women previously received LPSC and 15 (31.25%) developed interstitial pregnancies. The interval between pregnancy and the last surgery did not affect the frequency of interstitial pregnancy and gestational age. Fetal outcomes in patients with UR at the third trimester were better than those at the first and second trimesters. We suggest that close observation and timely treatment by experienced clinicians lead to good outcomes of pregnant women with suspected UR.
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Affiliation(s)
- Zhifen Hua
- Department of Obstetrics, Changning Maternity & Infant Health Hospital of Shanghai, Shanghai, China
| | - Minjun Wu
- Department of Obstetrics, Changning Maternity & Infant Health Hospital of Shanghai, Shanghai, China
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11
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Hoyos LR. Reply to Drs. Max Brincat and Tom Holland letter to the editor re: Hoyos LR, et al. Outcomes in subsequent pregnancies after wedge resection for interstitial ectopic pregnancy: a retrospective cohort study. J Matern Fetal Neonatal Med 2019; 34:839-840. [PMID: 31062636 DOI: 10.1080/14767058.2019.1616691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Luis R Hoyos
- Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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12
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Hawkins L, Robertson D, Frecker H, Berger H, Satkunaratnam A. Spontaneous uterine rupture and surgical repair at 21 weeks gestation with progression to live birth: a case report. BMC Pregnancy Childbirth 2018; 18:132. [PMID: 29728141 PMCID: PMC5935985 DOI: 10.1186/s12884-018-1761-x] [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] [Received: 05/15/2017] [Accepted: 04/23/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Uterine rupture in the non-laboring uterus is a rare occurrence, which can lead to significant morbidity and mortality for the mother and fetus. Management of this presentation is complex at pre-viable gestations. CASE PRESENTATION A 35 year old primigravid woman with multiple previous myomectomies presented with spontaneous complete thickness uterine rupture at 21 weeks gestation. A 10 cm myometrial defect and iatrogenic amniotomy were surgically corrected with fetal preservation. This led to pregnancy continuation to 32 weeks gestation when elective cesarean delivery resulted in excellent neonatal outcome. CONCLUSIONS Early surgical diagnosis, multidisciplinary team approach, iatrogenic amniotomy and continuous two-layer myometrial closure were factors that contributed to pregnancy prolongation in this large myometrial rupture.
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Affiliation(s)
- Lesley Hawkins
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada
| | - Deborah Robertson
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada.,Department of Obstetrics and Gynaecology, St Michael's Hospital, 308-55 Queen St East, Toronto, ON, M5C1R6, Canada
| | - Helena Frecker
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada.,Department of Obstetrics and Gynaecology, Michael Garron Hospital, Suite 311, 658 Danforth Avenue, M4J5B9, Toronto, Ontario, Canada
| | - Howard Berger
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada.,Department of Obstetrics and Gynaecology, St Michael's Hospital, 308-55 Queen St East, Toronto, ON, M5C1R6, Canada
| | - Abheha Satkunaratnam
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada. .,Department of Obstetrics and Gynaecology, St Michael's Hospital, 308-55 Queen St East, Toronto, ON, M5C1R6, Canada.
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13
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Yazawa H, Takiguchi K, Ito F, Fujimori K. Uterine rupture at 33rd week of gestation after laparoscopic myomectomy with signs of fetal distress. A case report and review of literature. Taiwan J Obstet Gynecol 2018; 57:304-310. [DOI: 10.1016/j.tjog.2018.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/24/2022] Open
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Hoyos LR, Vilchez G, Allsworth JE, Malik M, Rodriguez-Kovacs J, Adekola H, Awonuga AO. Outcomes in subsequent pregnancies after wedge resection for interstitial ectopic pregnancy: a retrospective cohort study. J Matern Fetal Neonatal Med 2018; 32:2354-2360. [DOI: 10.1080/14767058.2018.1437411] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Luis R. Hoyos
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Gustavo Vilchez
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Missouri – Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Mokerrum Malik
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Javier Rodriguez-Kovacs
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Henry Adekola
- Division of Maternal–Fetal Medicine, Department of Obstetrics & Gynecology, Hurley Medical Center, Michigan State University, Flint Campus, Detroit, MI, USA
| | - Awoniyi O. Awonuga
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA
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15
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Uterine Rupture with Cesarean Scar Heterotopic Pregnancy with Survival of the Intrauterine Twin. Case Rep Obstet Gynecol 2016; 2016:6832094. [PMID: 28116191 PMCID: PMC5220436 DOI: 10.1155/2016/6832094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/14/2016] [Accepted: 12/04/2016] [Indexed: 02/06/2023] Open
Abstract
Background. Heterotopic pregnancy is a multiple gestation with both intrauterine and ectopic fetuses. A cesarean scar ectopic pregnancy is when the fetus has implanted over the previous hysterotomy site. A known complication of cesarean scar ectopic pregnancy is uterine rupture, which can cause great morbidity and mortality. Case. 28-year-old G5P3105 at 10 weeks with a dichorionic diamniotic gestation was found to have a ruptured uterus with expulsion of a cesarean scar ectopic pregnancy and retention of the intrauterine fetus. After uterine repair, the singleton gestation reached viability was delivered by emergent cesarean section for placental abruption. Conclusion. Safe management of cesarean ectopic pregnancy requires early diagnosis by ultrasonography. With early detection, management can focus on preventing maternal morbidity of uterine rupture and life-threatening hemorrhage.
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16
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Wang J, Huang D, Lin X, Saravelos SH, Chen J, Zhang X, Li T, Zhang S. Incidence of Interstitial Pregnancy After In Vitro Fertilization/Embryo Transfer and the Outcome of a Consecutive Series of 38 Cases Managed by Laparoscopic Cornuostomy or Cornual Repair. J Minim Invasive Gynecol 2016; 23:739-47. [DOI: 10.1016/j.jmig.2016.02.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/23/2016] [Accepted: 02/27/2016] [Indexed: 10/22/2022]
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17
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Surico D, Amadori R, Vigone A, D'Agostino C, Dessole M, Surico N. Successful delivery after surgical repair of uterine rupture at 15 weeks of gestation: case report and brief review. Eur J Obstet Gynecol Reprod Biol 2016; 204:5-8. [PMID: 27459146 DOI: 10.1016/j.ejogrb.2016.05.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/15/2016] [Accepted: 05/19/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Second-trimester uterine rupture is a rare disorder and it is unclear if it should be managed with caesarean section, repair or hysterectomy. This article provides a case report of second-trimester uterine rupture repair, and reviews the risk factors, signs and symptoms, suturing technique and newborn outcome. METHODS PubMed was searched using the terms 'uterine rupture', 'second trimester' and 'repair' Only cases of second-trimester uterine rupture repair that led to successful prolongation of pregnancy were included. RESULTS The main risk factor of uterine rupture is previous caesarean section (5/10, 50%). Eight of 10 cases presented with abdominal pain and three cases presented in shock. Haemoperitoneum was present in five cases. The mean and median gestational age at delivery were 33.4 and 33.5 weeks, respectively (range 28-37 weeks), with mean and median delayed interval delivery of 95.5 and 91 days, respectively (range 14-147 days). Neonatal outcome was good for 10 of 11 newborns. Despite the early onset of uterine rupture, there were no cases of extremely preterm delivery. One early preterm infant, seven moderate-to-late preterm infants and one term infant were delivered. CONCLUSIONS The lack of extremely preterm deliveries and good neonatal outcomes encourage attempts to repair the uterus after second-trimester rupture.
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Affiliation(s)
- D Surico
- Department of Obstetrics and Gynaecology, University of Eastern Piedmont, Novara, Italy
| | - R Amadori
- Department of Obstetrics and Gynaecology, University of Eastern Piedmont, Novara, Italy.
| | - A Vigone
- Department of Obstetrics and Gynaecology, University of Eastern Piedmont, Novara, Italy
| | - C D'Agostino
- Department of Obstetrics and Gynaecology, University of Eastern Piedmont, Novara, Italy
| | - M Dessole
- Department of Surgical, Microsurgical and Medical Sciences, Gynaecologic and Obstetric Clinic, University of Sassari, Sassari, Italy
| | - N Surico
- Department of Obstetrics and Gynaecology, University of Eastern Piedmont, Novara, Italy
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Xu HM, Shu C, Cui LF, He J. Uterine rupture in a setting of past tubal isthmus laparoscopic resection with successful maternal outcome and live birth: A case report. J OBSTET GYNAECOL 2016; 36:435-6. [PMID: 26800477 DOI: 10.3109/01443615.2015.1110119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hong-Mei Xu
- a The First Hospital of Jilin University , Changchun , China
| | - Chang Shu
- a The First Hospital of Jilin University , Changchun , China
| | - Li-Feng Cui
- a The First Hospital of Jilin University , Changchun , China
| | - Jin He
- a The First Hospital of Jilin University , Changchun , China
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Iemura A, Kondoh E, Kawasaki K, Fujita K, Ueda A, Mogami H, Baba T, Konishi I. Expectant management of a herniated amniotic sac presenting as silent uterine rupture: a case report and literature review. J Matern Fetal Neonatal Med 2014; 28:106-12. [DOI: 10.3109/14767058.2014.900533] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yazawa H, Endo S, Hayashi S, Suzuki S, Ito A, Fujimori K. Spontaneous uterine rupture in the 33rd week of IVF pregnancy after laparoscopically assisted enucleation of uterine adenomatoid tumor. J Obstet Gynaecol Res 2011; 37:452-7. [DOI: 10.1111/j.1447-0756.2010.01361.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Walid MS, Heaton RL. Diagnosis and laparoscopic treatment of cornual ectopic pregnancy. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2010; 8. [PMID: 20725587 PMCID: PMC2921813 DOI: 10.3205/000105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 05/29/2010] [Indexed: 11/30/2022]
Abstract
Cornual (interstitial) ectopic pregnancy is an uncommon variant of ectopic pregnancy which often poses a diagnostic and therapeutic challenge with a significant risk of rupturing and bleeding. We present a ruptured right cornual pregnancy and explain how to deal with such a case laparoscopically.
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Affiliation(s)
- M Sami Walid
- Medical Center of Central Georgia, Macon, GA 31201, USA.
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