Разрыв матки после миомэктомии, произведенной вне беременности

Abstract

Objective. To study the incidence and risk factors of uterine rupture (UR) in a scarred uterus after myomectomy during pregnancy and childbirth. Patients and methods. A retrospective analysis of UR after myomectomy during pregnancy and childbirth was carried out according to the study of 43 labor and delivery medical records of patients from various maternity hospitals in Moscow. Results. Uterine scar after myomectomy, especially when performed laparoscopically, in the presence of pronounced interstitial changes poses a significant threat to both the mother and the fetus. In 27 (62.8%) cases, UR occurred before childbirth in a full-term pregnancy. UR in a scarred uterus after myomectomy was characterized by untimely diagnosis and laparotomy in 8 (21.6%) patients, resulted in blood loss of 1,000-5,000 mL in 32 (74.4%) patients; adverse perinatal outcomes: out of 45 children (2 cases of twins), 11 (24.4%) died (2 with extremely low body weight), 4 (8.9%) born with severe asphyxia, 6 (13.3%) with moderate asphyxia, 10 (22.2%) with mild asphyxia. In 5 (11.6%) cases, UR was detected in the early postpartum period. Conclusion. UR in a scarred uterus after myomectomy is characterized by delayed diagnosis and underestimation of early symptoms. Laparotomy was performed when a rupture occurred, both for complete 32 (74.4%) and incomplete 11 (25.6%). Careful choice of surgical approach for myomectomy in patients planning pregnancy and timely assessment of the state of the uterine scar are recommended. In case of UR, organ preservation surgery is performed. Key words: myomectomy, uterine rupture, uterine scar after myomectomy