Laparoscopic uterine surgery as a risk factor for uterine rupture during pregnancy

Uterine rupture in patients with a history of hysteroscopy procedures: Case series and review of literature

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.

Single-Incision Plus One Port Laparoscopic Surgery for Myomectomy: A Retrospective Study

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.

Spontaneous rupture of an unscarred uterus during pregnancy: A rare but life-threatening emergency: Case series

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.

Analysis of Pregnancy Outcomes after Laparoscopic Myomectomy: A Retrospective Cohort Study

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 $\text{abortion}=0$ , $\text{premature}\text{birth}=1$ , and $\text{full}\text{term}=2$ . 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.

Spontaneous complete uterine rupture with protrusion of foetal limbs at the third trimester following laparoscopic cornuostomy: A case report

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.

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

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.

The effects of laparoscopic myomectomy and open surgery on uterine myoma patients' postoperative immuno-inflammatory responses, endocrine statuses, and prognoses: a comparative study

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.

Indicators for mode of delivery in pregnant women with uteruses scarred by prior caesarean section: a retrospective study of 679 pregnant women

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.

Spontaneous rupture of the uterus following salpingectomy: a case report and literature review

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.