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Shao L, Yang Z, Yan H, Xu R. Uterine rupture in patients with a history of hysteroscopy procedures: Case series and review of literature. Medicine (Baltimore) 2024; 103:e37428. [PMID: 38457539 PMCID: PMC10919467 DOI: 10.1097/md.0000000000037428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 03/10/2024] Open
Abstract
RATIONALE Uterine rupture during pregnancy poses significant risks to both the fetus and the mother, resulting in high mortality and morbidity rates. While awareness of uterine rupture prevention after a cesarean section has increased, insufficient attention has been given to cases caused by pregnancy following hysteroscopy surgery. PATIENT CONCERNS We report 2 cases here, both of whom had a history of hysteroscopy surgery and presented with severe abdominal pain during pregnancy. DIAGNOSES Both patients had small uterine ruptures, with no significant abnormalities detected on ultrasonography. The diagnosis was confirmed by a CT scan, which showed hemoperitoneum. INTERVENTIONS We performed emergency surgeries for the 2 cases. OUTCOMES We repaired the uterus in 2 patients during the operation. Both patients recovered well. The children survived. No abnormalities were detected during their follow-up visits. LESSONS Attention should be paid to the cases of pregnancy after hysteroscopy.
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Affiliation(s)
- Liping Shao
- Department of Obstetrics and Gynecology, Changzhou Cancer Hospital Changzhou Fourth People’s Hospital, Changzhou, Jiangsu, China
| | - Zhilong Yang
- Department of General Surgery, Nanjing Lishui People’s Hospital, Nanjing, Jiangsu, China
| | - Huifang Yan
- Department of Obstetrics and Gynecology, Nanjing Lishui People’s Hospital, Nanjing, Jiangsu, China
| | - Rong Xu
- Department of Obstetrics and Gynecology, Nanjing Lishui People’s Hospital, Nanjing, Jiangsu, China
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Niu G, Zhao H, Wang H, Zhao L, Zhai Y. Single-Incision Plus One Port Laparoscopic Surgery for Myomectomy: A Retrospective Study. J INVEST SURG 2023; 36:2221738. [PMID: 37336518 DOI: 10.1080/08941939.2023.2221738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of single-incision plus one port laparoscopic surgery (SILS + 1) for myomectomy. METHODS We retrospectively analyzed data from patients who underwent laparoendoscopic single-site myomectomy (LESS-M group, n = 40) and SILS + 1 (SILS + 1-M group, n = 40) for myomectomy at our hospital from October 2018 through December 2020. The patients' baseline demographic information and clinical data were compared between the two groups. RESULTS The results showed that no significant difference in basic characteristics or between the number, size, and location of uterine myomas between the two groups (p < 0.05). However, the surgery was more difficult and the total operating time was significantly longer in the LESS-M group compared to the SILS + 1-M group (83.5 ± 14.2 vs. 108.2 ± 18.1 min, p = 0.001). Moreover, the estimated intraoperative blood loss (113.4 ± 46.5 vs. 211.4 ± 60.3 ml, p = 0.001) and changes in hemoglobin level (13.1 ± 7.6 vs. 18.2 ± 6.0, p = 0.001) were significantly lower in the SILS + 1-M group compared to the LESS-M group. In addition, no serious intraoperative or postoperative complications occurred after surgery in either group. The clinical outcomes in the SILS + 1-M group were associated with a significant reduction in total surgical time compared to the LESS-M group (p < 0.05). CONCLUSION SILS + 1 for myomectomy is popular in clinics, with a satisfactory clinical effect.
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Affiliation(s)
- Gaoli Niu
- Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People's Hospital of Jiaozuo), Jiaozuo, China
| | - Hua Zhao
- Department of Gynecology and Obstetrics, Henan Provincial People's Hospital, Zhengzhou, China
| | - Hong Wang
- Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People's Hospital of Jiaozuo), Jiaozuo, China
| | - Lingli Zhao
- Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People's Hospital of Jiaozuo), Jiaozuo, China
| | - Yanhong Zhai
- Department of Gynecology and Obstetrics, Henan Provincial People's Hospital, Zhengzhou, China
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Chen Y, Cao Y, She JY, Chen S, Wang PJ, Zeng Z, Liang CY. Spontaneous rupture of an unscarred uterus during pregnancy: A rare but life-threatening emergency: Case series. Medicine (Baltimore) 2023; 102:e33977. [PMID: 37327264 PMCID: PMC10270498 DOI: 10.1097/md.0000000000033977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
RATIONALE In most cases, uterine rupture occurs during the third trimester of pregnancy or during labor. Even fewer reports have been published about the occurrence of this condition without a gynecologic history of any surgical procedure. Due to their scarcity and variable clinical presentation, early diagnosis of uterine rupture may be difficult, and if the diagnosis is not timely, the condition may be life-threatening. PATIENT CONCERNS Herein, 3 cases of uterine rupture from a single institution are described. Three patients are at different gestational weeks and all have no history of uterine surgery. They came to the hospital due to acute abdominal pain, which is characterized by severe and persistent pain in the abdomen, with no apparent vaginal bleeding. DIAGNOSES All 3 patients were diagnosed with uterine rupture during the operation. INTERVENTIONS One patient underwent uterine repair surgery; while the other 2 underwent subtotal hysterectomy due to persistent bleeding and pathological examination after surgery confirmed placenta implantation. OUTCOMES The patients recovered well after the operation, and no discomfort occurred in the follow-up. LESSONS Acute abdominal pain during pregnancy can pose both diagnostic and therapeutic challenges. It is important to consider the possibility of uterine rupture, even in cases where there is no history of prior uterine surgery. The key to the treatment of uterine rupture is to shorten the diagnosis time as much as possible, this potential complication should be carefully monitored for and promptly addressed to ensure the best possible outcomes for both the mother and the developing fetus.
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Affiliation(s)
- Yue Chen
- The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Department of Obstetrics and Gynecology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing Jiangsu, China
- Department of Obstetrics and Gynecology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Ying Cao
- Department of Obstetrics and Gynecology, Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jing-Yao She
- The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Si Chen
- Department of Obstetrics and Gynecology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing Jiangsu, China
- Department of Obstetrics and Gynecology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Pei-Juan Wang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing Jiangsu, China
- Department of Obstetrics and Gynecology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Zheng Zeng
- Department of Pathology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Chun-Yun Liang
- The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
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Analysis of Pregnancy Outcomes after Laparoscopic Myomectomy: A Retrospective Cohort Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9685585. [PMID: 35607646 PMCID: PMC9124068 DOI: 10.1155/2022/9685585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022]
Abstract
Objective. This study aimed to investigate the factors related to pregnancy outcomes after laparoscopic myomectomy. Methods. A retrospective review was conducted on 156 patients aged 18 to 45 years who underwent laparoscopic myomectomy in Ningbo Women and Children’s Hospital from January 2010 to December 2016. Follow-up medical records and information were collected on demographic variables, clinical variables, and postoperative pregnancy rate. The logistic regression model was used to assess the association between related factors and postoperative pregnancy rate or pregnancy outcome. The outcome indicators included
,
, and
. The chi-squared test or Fisher’s exact test was used to compare the differences in pregnancy outcomes, postpartum hemorrhage, and placenta adhesion between the cohorts. Results. The size of fibroids correlated with the postoperative pregnancy rate. The larger the fibroids, the lower the postoperative pregnancy rate, and the difference was statistically significant. The number of fibroids and placental adhesions was positively associated with postoperative pregnancy; the higher the number of fibroids, the higher the incidence of placental adhesions. However, the postoperative interval of pregnancy, fibroid size, and number and type of fibroids are not correlated with the pregnancy outcomes of postoperative patients. Conclusions. The size of myoma may influence the pregnancy rate of patients after laparoscopic myomectomy. The number of fibroids can affect the incidence of placental adhesions during postoperative pregnancy.
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Feng J, Kang Y, Chen G, Zhang Y, Li Y, Li Y, He H. Spontaneous complete uterine rupture with protrusion of foetal limbs at the third trimester following laparoscopic cornuostomy: A case report. Medicine (Baltimore) 2022; 101:e28955. [PMID: 35212306 PMCID: PMC8878629 DOI: 10.1097/md.0000000000028955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/11/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Spontaneous complete uterine rupture during gestation is rare and has no specific symptoms; however, it is a life-threatening event for both the fetus and mother. The rupture typically happens in labor and is uncommon before labor. Herein, we present the case of a woman, encountering complete rupture at third trimester followed by laparoscopic cornuostomy. PATIENT CONCERNS A 26-year-old woman presented with acute right lower abdominal pain at 33 weeks and 5 days of gestation. DIAGNOSES We made a diagnosis of threatened uterine rupture. INTERVENTION Urgent cesarean section performed. Exploration of the uterine dehiscence wound demonstrated that the myometrium was completely ruptured at the primary laparoscopic surgical scar with a defect of 40 mm, and live birth and preservation of the uterus was achieved. OUTCOME On the third day of operation, she had a good recovery and was discharged. After a 6-week postpartum follow-up, she displayed a good level of rehabilitation. LESSONS Pregnancy after laparoscopic cornuostomy should be treated as high-risk gestation and the rupture during gestation of the uterine scar should be suspected once lower abdominal pain occurred. Swift diagnosis and prompt intervention play a crucial role in saving the lives of the fetus and the mother.
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Affiliation(s)
- Jianyang Feng
- Department of Obstectrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yahui Kang
- Department of Gynecology, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou City, Gansu, China
| | - Guixian Chen
- Department of Obstectrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yaoyue Zhang
- Department of Obstectrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuan Li
- Department of Gynecology and Obstetrics, The People's Hospital of Nanchuan, Chongqing City, China
| | - Yi Li
- Department of Gynecology, Fengcheng Maternity and Child-Care Hospital, Yichun City, Jiangxi, China
| | - Hong He
- Department of Obstectrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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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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Tian Y, Chen J. The effects of laparoscopic myomectomy and open surgery on uterine myoma patients' postoperative immuno-inflammatory responses, endocrine statuses, and prognoses: a comparative study. Am J Transl Res 2021; 13:9671-9678. [PMID: 34540094 PMCID: PMC8430179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the effects of laparoscopic myomectomy and open surgery on the postoperative inflammatory responses, endocrine statuses, and prognoses of uterine myoma patients. METHODS Uterine myoma patients (n=126) admitted to the Department of Gynecology in our hospital were recruited as the study cohort and divided into an observation group (n=63), and a control group (n=63). The patients in the observation group underwent laparoscopic myomectomies, and the patients in the control group underwent open surgery. The completion times, intraoperative blood loss volumes, postoperative hospital stay durations, postoperative exhaust times, preoperative and postoperative immune function, inflammatory factors, sex hormone levels, postoperative complications, and prognoses were observed. RESULTS The observation group showed shorter hospital stays, lower intraoperative blood loss volumes, and shorter postoperative exhaust times (P<0.001). After the surgery, CD3+%, CD4+%, and CD4+%/CD8+% were decreased, but the CD8+% was increased in the two groups (all P<0.01). The observation group had higher CD3+%, CD4+% and CD4+%/CD8+%, and lower CD8+% than the control group (all P<0.001). The C-reactive protein, TNF-α, and IL-6 levels were higher after the surgery in the two groups (all P<0.05), but the observation group had lower levels (all P<0.001). The follicle-stimulating hormone and luteinizing hormone levels were lower, but the estradiol levels were higher in the observation group compared to the levels in the control group (all P<0.001). The total number of complications in the observation group was significantly lower than it was in the control group (P<0.05). CONCLUSION Laparoscopic myomectomy contributes to quick recoveries and short hospital stays, reduces the postoperative inflammatory response and immunosuppression, has little effect on the postoperative sex hormone levels, and has a low incidence of complications. It is worthy of clinical application.
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Affiliation(s)
- Yunling Tian
- Department of Gynecology, Jincheng People's Hospital Jincheng, Shanxi Province, China
| | - Jianqin Chen
- Department of Gynecology, Jincheng People's Hospital Jincheng, Shanxi Province, China
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Khaw SC, Anderson RA, Lui MW. Systematic review of pregnancy outcomes after fertility-preserving treatment of uterine fibroids. Reprod Biomed Online 2020; 40:429-444. [DOI: 10.1016/j.rbmo.2020.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/17/2019] [Accepted: 01/02/2020] [Indexed: 02/08/2023]
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Tinelli A, Favilli A, Lasmar RB, Mazzon I, Gerli S, Xue X, Malvasi A. The importance of pseudocapsule preservation during hysteroscopic myomectomy. Eur J Obstet Gynecol Reprod Biol 2019; 243:179-184. [DOI: 10.1016/j.ejogrb.2019.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/08/2019] [Accepted: 09/16/2019] [Indexed: 11/29/2022]
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Indicators for mode of delivery in pregnant women with uteruses scarred by prior caesarean section: a retrospective study of 679 pregnant women. BMC Pregnancy Childbirth 2019; 19:445. [PMID: 31775663 PMCID: PMC6882006 DOI: 10.1186/s12884-019-2604-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/14/2019] [Indexed: 11/26/2022] Open
Abstract
Background The delivery mode for pregnant women with uteruses scarred by prior caesarean section (CS) is a controversial issue, even though the CS rate has risen in the past 20 years. We performed this retrospective study to identify the factors associated with preference for CS or vaginal birth after CS (VBAC). Methods Pregnant women (n = 679) with scarred uteruses from Moulay Ali Cherif Provincial Hospital, Rashidiya, Morocco, were enrolled. Gestational age, comorbidity, fetal position, gravidity and parity, abnormal amniotic fluid, macrosomia, placenta previa or abruptio, abnormal fetal presentation, premature rupture of fetal membrane with labor failure, poor progression in delivery, and fetal outcomes were recorded. Results Out of 679 pregnant women ≥28 gestational weeks, 351 (51.69%) had a preference for CS. Pregnant women showed preference for CS if they were older (95% CI 1.010–1.097), had higher gestational age (95% CI 1.024–1.286), and a shorter period had passed since the last CS (95% CI 0.842–0.992). Prior gravidity (95% CI 0.638–1.166), parity (95% CI 0.453–1.235), vaginal delivery history (95% CI 0.717–1.818), and birth weight (95% CI 1.000–1.001) did not influence CS preference. In comparison with fetal preference, maternal preference was the prior indicator for CS. Correlation analysis showed that pregnant women with longer intervals since the last CS and history of gravidity, parity, and vaginal delivery showed good progress in the first and second stages of vaginal delivery. Conclusions We concluded that maternal and gestational age and interval since the last CS promoted CS preference among pregnant women with scarred uteruses.
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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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