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Ziadeh H, Panel P, Letohic A, Canis M, Amari S, Gauthier T, Niro J. Resection of deep-infiltrating endometriosis could be a risk factor for uterine rupture: a case series with review of the literature. F S Rep 2020; 1:213-218. [PMID: 34223247 PMCID: PMC8244271 DOI: 10.1016/j.xfre.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022] Open
Abstract
Objective To highlight the possible correlation between deep-infiltrating endometriosis (DIE) resection and subsequent uterine rupture. Design Case series and review of the literature. Setting Endometriosis referral hospitals. Patient(s) Seven young women who underwent laparoscopic resection of DIE, six of whom had uterine rupture before or during labor; the seventh patient had a posterior wall defect that placed her at increased risk of future uterine rupture. Intervention(s) Diagnosis of uterine rupture before or during labor in patients with a history of prior resection of DIE, leading to delivery by emergency delivery section or emergency laparotomy for exploration and repair. Main Outcome Measure(s) Immediate neonate and maternal salvaging caesarean delivery or laparotomy followed by surgical correction of the rupture. Result(s) As of 2019, no publications in the literature had considered uterine rupture among the obstetric complications of endometriosis. The reporting of such findings is crucial because of the increase in surgical management of endometriosis. We report seven cases of uterine rupture in pregnancy in women who had undergone resection of DIE. In six patients, surgeons found uterine rupture at the level of the previous resected endometriosis and diagnosed a posterior wall defect at the same level in one patient. Conclusion(s) Our case series sheds light on the potential increased risk of uterine rupture during pregnancy among women who have had a prior resection of DIE. In future, if these patients are considered high-risk pregnancy cases, their care should be managed by high-risk obstetric specialists.
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Affiliation(s)
- Hanane Ziadeh
- Department of Obstetrics and Gynecology, Versailles Hospital Center, Versailles, France
| | - Pierre Panel
- Department of Obstetrics and Gynecology, Versailles Hospital Center, Versailles, France
| | - Arnaud Letohic
- Department of Obstetrics and Gynecology, Versailles Hospital Center, Versailles, France
| | - Michel Canis
- Department of Obstetrics and Gynecology and Reproductive Biology, Estaing University Hospital, Clermont-Ferrand, France
| | - Sarah Amari
- Department of Obstetrics and Gynecology, Versailles Hospital Center, Versailles, France
| | - Tristan Gauthier
- Department of Obstetrics and Gynecology, Limoges University Hospital, Limoges, France
| | - Julien Niro
- Department of Obstetrics and Gynecology, Versailles Hospital Center, Versailles, France
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Leone Roberti Maggiore U, Inversetti A, Schimberni M, Viganò P, Giorgione V, Candiani M. Obstetrical complications of endometriosis, particularly deep endometriosis. Fertil Steril 2017; 108:895-912. [PMID: 29202964 DOI: 10.1016/j.fertnstert.2017.10.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/16/2017] [Accepted: 10/20/2017] [Indexed: 02/07/2023]
Abstract
Over the past few years, a new topic in the field of endometriosis has emerged: the potential impact of the disease on pregnancy outcomes. This review aims to summarize in detail the available evidence on the relationship between endometriosis, particularly deep endometriosis (DE), and obstetrical outcomes. Acute complications of DE, such as spontaneous hemoperitoneum, bowel perforation, and uterine rupture, may occur during pregnancy. Although these events represent life-threatening conditions, they are rare and unpredictable. Therefore, the current literature does not support any kind of prophylactic surgery before pregnancy to prevent such complications. Results on the impact of DE on obstetrical outcomes are debatable and characterized by several limitations, including small sample size, lack of adjustment for confounders, lack of adequate control subjects, and other methodologic flaws. For these reasons, it is not possible to draw conclusions on this topic. The strongest evidence shows that DE is associated with higher rates of placenta previa; for other obstetrical outcomes, such as miscarriage, intrauterine growth restriction, preterm birth and hypertensive disorders, results are controversial. Although it is unlikely that surgery of DE may modify the impact of the disease on the course of pregnancy, no study has yet investigated this issue.
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Affiliation(s)
| | - Annalisa Inversetti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa, Genoa, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Schimberni
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa, Genoa, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Veronica Giorgione
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa, Genoa, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa, Genoa, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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3
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From Endometriosis to Pregnancy: Which is the “Road-Map”? JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/jeppd.5000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the last decade, pregnancy was considered as a therapeutic period for patients affected by endometriosis and painful symptoms. However, several studies have taken into consideration how endometriosis affects pregnancy achievement and pregnancy development, including obstetric complications. The adverse effects of endometriosis on the development of pregnancy include miscarriage, hypertensive disorders and pre-eclampsia, placenta previa, obstetric hemorrhages, preterm birth, small for gestational age, and adverse neonatal outcomes. The aim of this review is to analyze the current literature regarding the relationship between different forms of endometriosis (endometrioma, peritoneal endometriosis, deep endometriosis) and infertility, and the impact of endometriosis on pregnancy outcomes.
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Delépine O, Curinier S, Agar N, Piquier-Perret G, Gallot D, Houlle C, Canis M, Pouly JL. [About a case of uterine per-partum rupture, 37months after resection of a rectovaginal endometriosis nodule]. ACTA ACUST UNITED AC 2016; 45:985-989. [PMID: 27496570 DOI: 10.1016/j.jgyn.2016.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
Endometriosis is a common condition in women, whose main repercussions are painful symptoms. In addition, it was shown that endometriosis was a major cause of infertility and various obstetric complications could be related to this pathology. Uterine rupture is a rare but serious complication whose incidence tends to decrease with the screening of women at risk, however, its fetal, maternal morbidity and mortality causes remains important. We were confronted with a case of posterior uterine rupture in a patient of 36 years, primipare term exceeded in immediate postpartum period. The patient's primary antecedent of uterine surgery torus was responsible for infertility endometriosis. The outcome was favorable for the mother, after a surgical treatment by laparotomy, and for the child. In the literature, two cases have been reported of uterine rupture after endometriosis surgery, which is why we found it interesting to report this rare case. Given the increase in surgical management of this disease, it seems relevant to ask whether, in the future, we should be more vigilant in monitoring pregnancy for these women.
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Affiliation(s)
- O Delépine
- Service de gynécologie-obstétrique des hôpitaux de Clermont-Ferrand, CHU Estaing, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
| | - S Curinier
- Service de gynécologie-obstétrique et biologie de la reproduction, CHU Estaing, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - N Agar
- Service de gynécologie-obstétrique et biologie de la reproduction, CHU Estaing, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - G Piquier-Perret
- Service de gynécologie-obstétrique et biologie de la reproduction, CHU Estaing, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - D Gallot
- Service de gynécologie-obstétrique et biologie de la reproduction, CHU Estaing, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - C Houlle
- Service de gynécologie-obstétrique et biologie de la reproduction, CHU Estaing, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - M Canis
- Service de gynécologie-obstétrique et biologie de la reproduction, CHU Estaing, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - J-L Pouly
- Service de gynécologie-obstétrique et biologie de la reproduction, CHU Estaing, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
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Leone Roberti Maggiore U, Ferrero S, Mangili G, Bergamini A, Inversetti A, Giorgione V, Viganò P, Candiani M. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update 2015; 22:70-103. [PMID: 26450609 DOI: 10.1093/humupd/dmv045] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/14/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Traditionally, pregnancy was considered to have a positive effect on endometriosis and its painful symptoms due not only to blockage of ovulation preventing bleeding of endometriotic tissue but also to different metabolic, hormonal, immune and angiogenesis changes related to pregnancy. However, a growing literature is emerging on the role of endometriosis in affecting the development of pregnancy and its outcomes and also on the impact of pregnancy on endometriosis. The present article aims to underline the difficulty in diagnosing endometriotic lesions during pregnancy and discuss the options for the treatment of decidualized endometriosis in relation to imaging and symptomatology; to describe all the possible acute complications of pregnancy caused by pre-existing endometriosis and evaluate potential treatments of these complications; to assess whether endometriosis affects pregnancy outcome and hypothesize mechanisms to explain the underlying relationships. METHODS This systematic review is based on material searched and obtained via Pubmed and Medline between January 1950 and March 2015. Peer-reviewed, English-language journal articles examining the impact of endometriosis on pregnancy and vice versa were included in this article. RESULTS Changes of the endometriotic lesions may occur during pregnancy caused by the modifications of the hormonal milieu, posing a clinical dilemma due to their atypical appearance. The management of these events is actually challenging as only few cases have been described and the review of available literature evidenced a lack of formal estimates of their incidence. Acute complications of endometriosis during pregnancy, such as spontaneous hemoperitoneum, bowel and ovarian complications, represent rare but life-threatening conditions that require, in most of the cases, surgical operations to be managed. Due to the unpredictability of these complications, no specific recommendation for additional interventions to the routinely monitoring of pregnancy of women with known history of endometriosis is advisable. Even if the results of the published studies are controversial, some evidence is suggestive of an association of endometriosis with spontaneous miscarriage, preterm birth and small for gestational age babies. A correlation of endometriosis with placenta previa (odds ratio from 1.67 to 15.1 according to various studies) has been demonstrated, possibly linked to the abnormal frequency and amplitude of uterine contractions observed in women affected. Finally, there is no evidence that prophylactic surgery would prevent the negative impact of endometriosis itself on pregnancy outcome. CONCLUSIONS Complications of endometriosis during pregnancy are rare and there is no evidence that the disease has a major detrimental effect on pregnancy outcome. Therefore, pregnant women with endometriosis can be reassured on the course of their pregnancies although the physicians should be aware of the potential increased risk of placenta previa. Current evidence does not support any modification of conventional monitoring of pregnancy in patients with endometriosis.
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Affiliation(s)
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Annalisa Inversetti
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Veronica Giorgione
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Via Olgettina 58, 20132 Milano, Italy
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Vigano P, Corti L, Berlanda N. Beyond infertility: obstetrical and postpartum complications associated with endometriosis and adenomyosis. Fertil Steril 2015; 104:802-812. [DOI: 10.1016/j.fertnstert.2015.08.030] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 11/17/2022]
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Fettback PB, Pereira RMA, Domingues TS, Zacharias KG, Chamié LP, Serafini PC. Uterine rupture before the onset of labor following extensive resection of deeply infiltrating endometriosis with myometrial invasion. Int J Gynaecol Obstet 2015; 129:268-70. [PMID: 25887944 DOI: 10.1016/j.ijgo.2015.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 11/04/2014] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | | | | | | | | | - Paulo C Serafini
- Huntington Centro de Medicina Reprodutiva, São Paulo, Brazil; Discipline of Gynecology of São Paulo School of Medicine, Center for Human Reproduction, University of São Paulo Medical School, São Paulo, Brazil.
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Odejinmi F, Annan J, Wong I. Pre-labour spontaneous uterine rupture at 31 weeks' gestation following laparoscopic excision of a broad ligament paramesonephric cyst and literature review. J OBSTET GYNAECOL 2011; 31:444-5. [PMID: 21627433 DOI: 10.3109/01443615.2011.573107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- F Odejinmi
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, London, UK.
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Kovoor E, Nassif J, Miranda-Mendoza I, Baulon E, Wattiez A. Hematometra following laparoscopic resection of retrocervical and rectovaginal endometriosis. Fertil Steril 2010; 93:2074.e11-2. [PMID: 20074728 DOI: 10.1016/j.fertnstert.2009.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 09/21/2009] [Accepted: 10/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report a case of hematometra following laparoscopic resection of rectovaginal endometriosis extending to the cervix. DESIGN Case report. SETTING University hospital. PATIENT(S) A 31-year-old woman with endometriosis and infertility. INTERVENTION(S) Combined laparoscopic and vaginal surgery. RESULT(S) The cervix had retracted into the vaginal scar after surgery, preventing the escape of menstrual blood. The hematometra was drained, and the cervix was repositioned into the vagina with use of a combined vaginal and laparoscopic approach. CONCLUSION(S) Retraction of the cervix into the cul-de-sac can occur as a complication of excision of rectovaginal nodules that extend onto the posterior surface of the cervix. Excision of the posterior cervix should avoid deep excision of the posterior lip and should be limited only to the ectocervical margin to avoid such complications.
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Affiliation(s)
- Elias Kovoor
- Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD) and University Hospitals Strasbourg, Strasbourg, France.
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Villa G, Mabrouk M, Guerrini M, Mignemi G, Colleoni GG, Venturoli S, Seracchioli R. Uterine rupture in a primigravida with adenomyosis recently subjected to laparoscopic resection of rectovaginal endometriosis: case report. J Minim Invasive Gynecol 2008; 15:360-1. [PMID: 18439512 DOI: 10.1016/j.jmig.2007.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Revised: 10/26/2007] [Accepted: 10/29/2007] [Indexed: 10/22/2022]
Abstract
A case of intrapartum, complete, low-posterior wall, transverse uterine rupture, complicated by uterine atony and treated by emergency hysterectomy in a primigravida with uterine adenomyosis who delivered vaginally at 37 weeks plus 5 days of gestation, 9 months after undergoing laparoscopic resection of rectovaginal septum endometriosis.
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Affiliation(s)
- Gioia Villa
- Centre of Reconstructive Pelvic Endo-surgery, Reproductive Medicine Unit, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Asakura H, Oda T, Tsunoda Y, Matsushima T, Kaseki H, Takeshita T. A Case Report: Change in Fetal Heart Rate Pattern on Spontaneous Uterine Rupture at 35 Weeks Gestation after Laparoscopically Assisted Myomectomy. J NIPPON MED SCH 2004; 71:69-72. [PMID: 15129599 DOI: 10.1272/jnms.71.69] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 31-year-old nulligravid woman who underwent laparoscopically assisted myomectomy 5 months before becoming pregnant suffered uterine rupture at 35 weeks gestation. A 50 g intramuscular myomatous node had been removed laparoscopically. Early signs of rupture included sudden onset of severe abdominal tenderness and frequent uterine contractions despite reassuring FHR tracing. Variable deceleration was observed as late as 7.5 hours after onset. Emergency cesarean section was performed due to increasing severity of tenderness, revealing complete uterine rupture at the fundus site without extrusion of the fetus or placenta. A male neonate (2,860 g) was delivered without asphyxia and an Apgar score of 8. Total volume of hemorrhage was approximately 50 ml. The ruptured uterine wall was repaired by suturing in 2 layers. The present case indicates that sudden onset of abdominal tenderness in pregnant women with a history of laparoscopic myomectomy may suggest uterine rupture even in the presence of reassuring FHR. This is a rare case, as non-reassuring FHR patterns generally appear in the late stages of uterine rupture.
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Affiliation(s)
- Hirobumi Asakura
- Department of Obstetrics and Gynecology, Nippon Medical School Second Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan.
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Brosens IA, Brosens JJ. Redefining endometriosis: is deep endometriosis a progressive disease? Hum Reprod 2000; 15:1-3. [PMID: 10611177 DOI: 10.1093/humrep/15.1.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- I A Brosens
- Leuven Institute for Fertility and Embryology, Leuven, Belgium, and Department of Reproductive Sciences and Medicine, Division of Paediatrics, Obstetrics and Gynaecology, ICSM at Hammersmith Hospital, London, UK
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