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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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Ogoyama M, Yamamoto K, Suzuki H, Takahashi H, Fujiwara H. Uterine Rupture With Placenta Percreta Following Multiple Adenomyomectomies. Cureus 2023; 15:e34852. [PMID: 36923199 PMCID: PMC10009651 DOI: 10.7759/cureus.34852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2023] [Indexed: 02/13/2023] Open
Abstract
Pregnancy following adenomyomectomy is challenging because uterine rupture or placenta accreta spectrum (PAS) is more likely to occur; however, optimal management has not yet been established. We herein present a case of uterine rupture with placenta percreta in a pregnant woman who underwent adenomyomectomy twice before pregnancy. Magnetic resonance imaging (MRI) was performed in the second trimester and imminent uterine rupture concomitant with PAS was suspected. The patient was immediately admitted to hospital for careful management. Although failed tocolysis forced delivery at 29 weeks of gestation, managed hospitalization allowed cesarean hysterectomy to be performed uneventfully. Extensive PAS was proven pathologically in the removed uterus. Pregnancies following multiple adenomyomectomies are considered to be high-risk. Therefore, a sufficient explanation of the risks associated with future pregnancies is needed, particularly following second adenomyomectomy.
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Affiliation(s)
- Manabu Ogoyama
- Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, JPN
| | - Kazuki Yamamoto
- Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, JPN
| | - Hirotada Suzuki
- Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, JPN
| | | | - Hiroyuki Fujiwara
- Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, JPN
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3
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Savukyne E, Bykovaite-Stankeviciene R, Machtejeviene E, Nadisauskiene R, Maciuleviciene R. Symptomatic Uterine Rupture: A Fifteen Year Review. ACTA ACUST UNITED AC 2020; 56:medicina56110574. [PMID: 33138157 PMCID: PMC7693983 DOI: 10.3390/medicina56110574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/23/2022]
Abstract
Background and objectives: To assess the incidence of complete and partial uterine rupture during childbirth in a single tertiary referral centre as well as the significant risk factors, symptoms and peripartum complications. Materials and Methods: A retrospective single-centre study involved all cases of uterine rupture at the Kaunas Perinatal Centre in 2004–2019. Data were from a local medical database complemented with written information from medical records. We included 45,893 women with an intact uterus and 5630 with uterine scars. Women (n = 5626) with scarred uterus’ after previous cesarean delivery. The diagnosis was defined by clinical symptoms, leading to an emergency cesarean delivery, when complete or partial uterine rupture (n = 35) was confirmed. Asymptomatic cases, when uterine rupture was found at elective cesarean section (n = 3), were excluded. The control group is represented by all births delivered in our department during the study period (n = 51,525). The outcome was complete (tearing of all uterine wall layers, including serosa and membranes) and partial uterine rupture (uterine muscle defect but intact serosa), common uterine rupture symptoms. Risk factors were parameters related to pregnancy and labour. Results: 51,525 deliveries occurred in Kaunas Perinatal Centre during the 15 years of the study period. A total number of 35 (0.06%) symptomatic uterine ruptures were recorded: 22 complete and 13 partial, leading to an incidence rate of 6.8 per 10,000 deliveries. The uterine rupture incidence rate after a single previous cesarean delivery is 44.4 per 10,000 births. 29 (83%) cases had a uterine scar after previous cesarean, 4 (11%) had a previous laparoscopic myomectomy, 2 (6%) had an unscarred uterus. The most significant risk factors of uterine rupture include uterine scarring and augmentation or epidural anaesthesia in patients with a uterine scar after cesarean delivery. The most common clinical sign was acute abdominal pain in labour 18 (51%). No maternal, six intrapartum perinatal deaths (17%) occurred, and one hysterectomy (2.8%) was performed due to uterine rupture. Neonatal mortality reached 22% among the complete ruptures. Average blood loss was 1415 mL, 4 (11%) patients required blood transfusion. Conclusions: The incidence rate of uterine rupture (complete and incomplete) at Kaunas Perinatal Centre is 6.8 per 10,000 deliveries. In cases with a scar of the uterus after a single cesarean, the incidence of uterine rupture is higher, exceeding 44 cases per 10,000 births. The most significant risk factors were uterine scar and augmentation or epidural anaesthesia in a previous cesarean delivery. Acute abdominal pain in labour is the most frequent symptom for uterine rupture.
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Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynaecology, Jichi Medical University, Tochigi, Japan
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5
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Sugiyama M, Takahashi H, Baba Y, Taneichi A, Suzuki H, Usui R, Takei Y, Ohkuchi A, Fujiwara H, Matsubara S. Perinatal outcome of pregnancy after adenomyomectomy: summary of 10 cases with a brief literature review. J Matern Fetal Neonatal Med 2019; 33:4145-4149. [PMID: 30889999 DOI: 10.1080/14767058.2019.1597845] [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: 10/27/2022]
Abstract
Objectives: The purpose of this study was the perinatal outcomes of patients who became pregnant after adenomyomectomy.Study design: The retrospective cohort study was performed involving pregnant women with a history of adenomyomectomy between 1 January 2011 and 31 December 2018. At 24-26 weeks, the patients were admitted even without symptoms or signs. When regular uterine contractions were observed, tocolysis was performed.Results: Ten patients were included. Elective and emergent cesarean section (CS) was performed in seven and three patients, respectively. Emergent CS was performed due to onset of labor (tocolytic failure) at 28, 24, and 32 weeks. Although no patients suffered uterine rupture, myometrial thinning was observed at the site corresponding to that of adenomyomectomy in three patients. Of these three patients, two required emergent CS due to tocolytic failure with cervical length (CL) shortening. In contrast, CLs were stable in the other seven patients with elective CS.Conclusions: Three patients after adenomyomectomy showed preterm delivery, and three had a very thin uterus to the extent that the fetus could be observed through the uterine wall. A short CL should be paid special attention in pregnant women with a history of adenomyomectomy.
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Affiliation(s)
- Mizuho Sugiyama
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hironori Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yosuke Baba
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Akiyo Taneichi
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hirotada Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Rie Usui
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yuji Takei
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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6
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Kwack JY, Im KS, Kwon YS. Conservative surgery of uterine adenomyosis via laparoscopic versus laparotomic approach in a single institution. J Obstet Gynaecol Res 2018; 44:1268-1273. [DOI: 10.1111/jog.13658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 03/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Jae Young Kwack
- Department of Obstetrics and Gynaecology, Ulsan University Hospital; University of Ulsan College of Medicine; Dong-gu Ulsan South Korea
| | - Kyong Shil Im
- Department of Anesthesiology and Pain Medicine, College of Medicine; Catholic University of Korea; Uijeongbu South Korea
| | - Yong-Soon Kwon
- Department of Obstetrics and Gynaecology, Ulsan University Hospital; University of Ulsan College of Medicine; Dong-gu Ulsan South Korea
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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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8
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Osada H. Uterine adenomyosis and adenomyoma: the surgical approach. Fertil Steril 2018; 109:406-417. [DOI: 10.1016/j.fertnstert.2018.01.032] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/14/2018] [Accepted: 01/20/2018] [Indexed: 11/28/2022]
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9
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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.
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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
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10
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Kwack JY, Kwon YS. Conservative surgery of diffuse adenomyosis with TOUA: Single surgeon experience of one hundred sixteen cases and report of fertility outcomes. Kaohsiung J Med Sci 2018; 34:290-294. [PMID: 29699636 DOI: 10.1016/j.kjms.2017.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/13/2017] [Accepted: 12/11/2017] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to evaluate the clinical outcomes of conservative adenomyomectomy with TOUA for diffuse uterine adenomyosis and to determine the feasibility and safety. One hundred and sixteen patients with symptomatic diffuse uterine adenomyosis underwent adenomyomectomy with TOUA by a single surgeon at Ulsan University Hospital between May 2011 and March 2016. Surgical outcomes included operative time, intraoperative injury and operative blood loss. We assessed the degree of improvement in dysmenorrhea and menorrhagia at the 7-month follow-up visit after the operation. The mean age of patients was 37.49 years (range: 26-49). The mean total surgical time was 116.12 min (range: 60-300, SD: 37.27). The mean estimated blood loss was 207.22 mL (range: 30-1200, SD: 161.08) and there were no cases of injury to the uterine arteries or pelvic nerves. The mean duration of hospital stay was 5.05 days (range: 4-7, SD: 0.68) and the mean follow-up period of 16.67 months (range: 6-49, SD: 12.77). At the 7-month follow-up after adenomyomectomy with TOUA, dysmenorrhea and menorrhagia were improved in 100% and 89% of the patients, respectively. In patients with diffuse uterine adenomyosis, even when the whole uterus is involved, for relief of severe adenomyosis-related symptoms, adenomyomectomy with TOUA could be a safe and effective surgical treatment option for those who want to preserve their fertility.
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Affiliation(s)
- Jae-Young Kwack
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Republic of Korea
| | - Yong-Soon Kwon
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Republic of Korea.
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11
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Matsuhashi T, Matsui R, Hasegawa C, Hatori T, Kamoi S, Takeshita T. Laparoscopic Excision of a Uterine Adenomatoid Tumor and a Coexisting Ovarian Teratoma: A Case Report and Literature Review. J NIPPON MED SCH 2017; 84:139-143. [PMID: 28724848 DOI: 10.1272/jnms.84.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Adenomatoid tumors (ATs) are rare, benign neoplasms occurring mainly in reproductive organs such as the uterus, ovaries, fallopian tubes, and testes. Uterine adenomatoid tumors (UATs) are generally incidentally diagnosed during histopathological examination of excisional biopsies performed for other indications, most commonly uterine leiomyomas. We herein present a 38-year-old woman who underwent laparoscopic excision of a uterine leiomyoma and a right ovarian teratoma. Microscopic examination of the excisional biopsy revealed that the enucleated uterine tumor was composed of proliferating glandular tissue covered with single-layered cells that were surrounded by proliferating smooth muscle cells, corresponding exactly to the features of UATs. The excised ovarian cyst was confirmed to be a typical mature cystic teratoma. According to these histopathological findings, the patient was finally diagnosed with a UAT and coexisting teratoma. No recurrence was detected up to 6 months after excision. To the best of our knowledge, this is the eighth case report on laparoscopically enucleated UATs. Although recurrence risk may be low in UATs, further case reports are necessary to elucidate the safety and validity of laparoscopic excision for UATs.
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Affiliation(s)
- Tomohiko Matsuhashi
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital
| | - Ryoko Matsui
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital
| | - Chikako Hasegawa
- Department of Pathology, Nippon Medical School Chiba Hokusoh Hospital
| | - Tsutomu Hatori
- Department of Pathology, Nippon Medical School Chiba Hokusoh Hospital
| | - Seiryu Kamoi
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital
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12
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Second-trimester spontaneous uterine rupture after laparoscopic electromyolysis in nulligravida: A case report. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2016.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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13
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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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Nagao Y, Osato K, Kubo M, Kawamura T, Ikeda T, Yamawaki T. Spontaneous uterine rupture in the 35th week of gestation after laparoscopic adenomyomectomy. Int Med Case Rep J 2015; 9:1-4. [PMID: 26719729 PMCID: PMC4690644 DOI: 10.2147/imcrj.s94363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Uterine rupture rarely occurs during pregnancy, but it is a critical situation if so. It is already known that a history of uterine surgeries, such as cesarean section or myomectomy, is a risk factor for uterine rupture. Currently, the laparoscopic adenomyomectomy is a widely performed procedure, but associated risks have not been defined. We observed a case of spontaneous uterine rupture in a patient during the 35th week of gestation, after a laparoscopic adenomyomectomy. A 42-year-old, gravida 2, para 0 woman became pregnant after a laparoscopic adenomyomectomy and her pregnancy was conventional. At a scheduled date in the 35th week of gestation, after combined spinal epidural anesthesia and frequent uterine contractions, a weak pain suddenly ensued. After 13 minutes of uterine contractions, vaginal bleeding was evident. A cesarean section was performed, and the uterine rupture was found in the scar. After a laparoscopic adenomyomectomy, a pregnant uterus can easily rupture by rather weak and short uterine contractions, and is characterized by vaginal bleeding. When uterine bleeding is observed in pregnant women that have a history of adenomyomectomy, one should consider uterine rupture.
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Affiliation(s)
- Yukari Nagao
- Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital, Aichi, Japan ; Department of Obstetrics and Gynecology, Japanese Red Cross Ise Hospital, Mie, Japan
| | - Kazuhiro Osato
- Department of Obstetrics and Gynecology, Japanese Red Cross Ise Hospital, Mie, Japan ; Department of Obstetrics and Gynecology, School of Medicine, Mie University, Mie, Japan
| | - Michiko Kubo
- Department of Obstetrics and Gynecology, Japanese Red Cross Ise Hospital, Mie, Japan
| | - Takuya Kawamura
- Department of Obstetrics and Gynecology, Japanese Red Cross Ise Hospital, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, School of Medicine, Mie University, Mie, Japan
| | - Takaharu Yamawaki
- Department of Obstetrics and Gynecology, Japanese Red Cross Ise Hospital, Mie, Japan
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15
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Otsubo Y, Nishida M, Arai Y, Ichikawa R, Taneichi A, Sakanaka M. Association of uterine wall thickness with pregnancy outcome following uterine-sparing surgery for diffuse uterine adenomyosis. Aust N Z J Obstet Gynaecol 2015; 56:88-91. [DOI: 10.1111/ajo.12419] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Yasuo Otsubo
- Department of Obstetrics and Gynecology; National Hospital Organization; Kasumigaura Medical Center; Tsuchiura Ibaraki Japan
| | - Masato Nishida
- Department of Obstetrics and Gynecology; National Hospital Organization; Kasumigaura Medical Center; Tsuchiura Ibaraki Japan
| | - Yuko Arai
- Department of Obstetrics and Gynecology; National Hospital Organization; Kasumigaura Medical Center; Tsuchiura Ibaraki Japan
| | - Ryota Ichikawa
- Department of Obstetrics and Gynecology; National Hospital Organization; Kasumigaura Medical Center; Tsuchiura Ibaraki Japan
| | - Akiyo Taneichi
- Department of Obstetrics and Gynecology; Jichi Medical University; Shimotsuke Tochigi Japan
| | - Miyako Sakanaka
- Department of Obstetrics and Gynecology; National Hospital Organization; Kasumigaura Medical Center; Tsuchiura Ibaraki Japan
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16
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Kil K, Chung JE, Pak HJ, Jeung IC, Kim JH, Jo HH, Kim MR. Usefulness of CA125 in the differential diagnosis of uterine adenomyosis and myoma. Eur J Obstet Gynecol Reprod Biol 2014; 185:131-5. [PMID: 25577553 DOI: 10.1016/j.ejogrb.2014.12.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/25/2014] [Accepted: 12/05/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the usefulness of CA125 levels in the differential diagnosis of adenomyosis and myoma. This has been addressed by few, if any, previous studies. STUDY DESIGN Preoperative serum CA125 levels were measured in 2149 women who were diagnosed at total hysterectomy as having adenomyosis, myoma, endometriosis, and/or normal pelvis. Their medical records were retrieved and reviewed. RESULTS The mean serum CA125 level in the adenomyosis patients was significantly greater than that in the patients diagnosed with myoma (65.21±96.60 U/mL vs.12.86±14.23 U/mL, respectively; P<0.001). In the differential diagnosis of adenomyosis and myoma, the cut-off serum CA125 level with the highest accuracy (78.8%) and highest diagnostic value (61.2%) was 19 U/mL. Using this cut-off value, the negative predictive value was 69.5%, and the positive predictive value was 76.5%. These results are clearly superior to those of the empirical single cut-off value of 35 U/mL. Receiver operating characteristic curve analysis revealed the area under the curve for differentiating adenomyosis from myoma was 0.776, indicating good diagnostic performance. CONCLUSION In the differential diagnosis of adenomyosis and myoma, cut-off values for CA125, particularly the cut-off value of 19 U/mL, provide improved diagnostic performance. Serum CA125 testing can be performed during the initial screening of women with possible adenomyosis to differentiate this condition from myoma, although the diagnostic accuracy of using CA125 testing alone is limited.
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Affiliation(s)
- Kicheol Kil
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Sucho-gu, Seoul 137-701, Republic of Korea
| | - Jae-Eun Chung
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Sucho-gu, Seoul 137-701, Republic of Korea
| | - Ho Jeong Pak
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Sucho-gu, Seoul 137-701, Republic of Korea
| | - In-Cheul Jeung
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Sucho-gu, Seoul 137-701, Republic of Korea
| | - Jang Heub Kim
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Sucho-gu, Seoul 137-701, Republic of Korea
| | - Hyun Hee Jo
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Sucho-gu, Seoul 137-701, Republic of Korea
| | - Mee-Ran Kim
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Sucho-gu, Seoul 137-701, Republic of Korea.
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17
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Laparoscopic assisted adenomyomectomy using double flap method. Obstet Gynecol Sci 2014; 57:128-35. [PMID: 24678486 PMCID: PMC3965696 DOI: 10.5468/ogs.2014.57.2.128] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 07/13/2013] [Accepted: 08/07/2013] [Indexed: 11/09/2022] Open
Abstract
Objective The purpose of this study was to evaluate postoperative prognosis and progression in patients who received laparoscopic-assisted adenomyomectomy using the double flap method. Methods The pelvic cavity was explored by the conventional laparoscopic method, and drainage was achieved through a 5-mm trocar. After a small incision in the abdomen, the uterus was incised from the fundus to the upper cervical margin until exposing the endometrial cavity. Adenomyotic tissue was removed using a scalpel, scissors, or monopolar electrical bovie. The endometrial cavity was repaired with interrupted sutures using 2-0 vicryl. One side of the serosal flap was used to cover the endometrial side of the uterus. The second serosal flap covered the first flap after removal of the serosal surface of the first flap. Results From January 2008 to March 2012, there were 11 cases of laparoscopic-assisted adenomyomectomy at Chungnam National University Hospital. Nine cases were analyzed, excluding two cases with less than one year of follow-up. The average patient age was 37.0 years and average follow-up duration was 32.8 months. All patients showed improvement in dysmenorrhea (P < 0.001) and hypermenorrhea (P = 0.001) after surgery and were evaluated by visual analogue scale score. However, symptoms of adenomyosis were aggravated in three patients. Adenomyosis was progressed in the side opposite the site of operation. One patient required a total laparoscopic hysterectomy 27 months after surgery. Conclusion Laparoscopic-assisted adenomyomectomy using the double flap method is effective for uterine reduction and relief of dysmenorrhea and hypermenorrhea. Conservative management and careful follow-up are needed because adenomyosis can recur or progress in some patients.
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Misra M, Roychowdhury R, Sarkar NC, Koley MM. The spontaneous prelabour rupture of anunscarred uterus at 34 weeks of pregnancy. J Clin Diagn Res 2013; 7:548-9. [PMID: 23634419 DOI: 10.7860/jcdr/2013/4496.2820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 01/07/2013] [Indexed: 11/24/2022]
Abstract
Uterine rupture is an obstetric emergency needs immediate surgery and is associated with poor fetal & maternal outcome. Usually uterine rupture occurs at the lower segment (weakest part) if there is no history of uterine surgery. We hereby are reporting a case of spontaneous uterine rupture at fundus, at 34 weeks of gestation in a patient who has never had uterine surgery. Only uterine curettage was done once for missed abortion. In this case, diagnosis was delayed until the patient went into massive hemorrhagic shock; because, there was no history of previous uterine surgery. However, clinical picture of the ruptured uterus at the fundus suggests there was some weakness at the fundus. Thereafter, D & C operation was taken into account. Subtotal hysterectomy was done as the rupture was irreparable damage to the fundus. Her one month follow up was uneventful.
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Affiliation(s)
- Malabika Misra
- Assistant Professor, Department of Obstetrics and Gynaecology
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Matsubara S. “Masked uterine rupture”: key to diagnosis. Arch Gynecol Obstet 2012; 286:1075-6. [DOI: 10.1007/s00404-012-2370-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 04/24/2012] [Indexed: 10/28/2022]
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Sun HD, Su WH, Chang WH, Wen L, Huang BS, Wang PH. Rupture of a pregnant unscarred uterus in an early secondary trimester: a case report and brief review. J Obstet Gynaecol Res 2012; 38:442-5. [PMID: 22229814 DOI: 10.1111/j.1447-0756.2011.01723.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Rupture of a pregnant uterus in early pregnancy and an unscarred uterus are extremely rare, and some non-specific symptoms might appear before this occurrence. We report the case of a multiparous woman (gravida 3, para 2) with uterine fundal rupture in her early second trimester (17+ weeks of gestational age), who presented upper abdominal discomfort and vomiting for 3 days, and progressed into sudden acute abdomen and shock. During emergent laparotomy, the entire amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus. Although we could not confirm that the appearance of upper gastrointestinal symptoms and severe vomiting was associated with uterine rupture in this pregnant woman, abdominal symptoms or signs might be a hint or cause of severe catastrophic pregnancy-related complications.
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Affiliation(s)
- Hsu-Dong Sun
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Ban Ciao, New Taipei City, Taiwan
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Matsubara S, Kuwata T, Sata N. Occluded uterine rupture: Preventing catastrophe, preventing early diagnosis. J Obstet Gynaecol Res 2011; 38:350. [DOI: 10.1111/j.1447-0756.2011.01714.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Uccella S, Cromi A, Bogani G, Zaffaroni E, Ghezzi F. Spontaneous prelabor uterine rupture in a primigravida: a case report and review of the literature. Am J Obstet Gynecol 2011; 205:e6-8. [PMID: 22035954 DOI: 10.1016/j.ajog.2011.08.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 08/05/2011] [Accepted: 08/15/2011] [Indexed: 11/18/2022]
Abstract
A rare case of prelabor uterine rupture in a primigravida was reported. A woman with a history of uterine perforation during hysteroscopy became pregnant after donor oocyte in vitro fertilization. To provide more insight into the possible risk factors for prelabor uterine rupture in primigravidae, a literature review was performed.
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Affiliation(s)
- Stefano Uccella
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
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