Spontaneous uterine rupture in the 33rd week of IVF pregnancy after laparoscopically assisted enucleation of uterine adenomatoid tumor

Abstract

Although a uterine leiomyomectomy or adenomyomectomy is an accepted procedure to treat symptoms such as dysmenorrhea or hypermenorrhea to enhance fertility, the risk of future uterine rupture is a major concern for patients who become pregnant following these surgery. Although uterine rupture very rarely occurs, this is the most feared complication in pregnancy and is associated with a high rate of maternal and fetal morbidity and mortality. A 37-year-old nulliparous woman had a 2-year history of infertility. A transvaginal ultrasound revealed multiple uterine tumors that resembled leiomyomas on the posterior and fundal walls of the uterine body. After the patient had three failed in vitro fertilization and embryo transfer treatments, the uterine tumor was enucleated, and pathologically diagnosed as an adenomatoid tumor. Five months after the operation, the patient became pregnant as a result of a fourth in vitro fertilization and embryo transfer. At the 33rd week of gestation, she complained of a sudden onset of abdominal pain. The patient was diagnosed with a ruptured uterus based on an ultrasound, and an emergency cesarean section was performed. The rupture occurred at the site of the operation scar on the posterior wall of the uterine body. The fetal legs extruded into the abdominal cavity from the uterine cavity but were enclosed within the unruptured chorioamniotic membrane. A male neonate (1956 g) was delivered without asphyxia and had Apgar scores of 8 and 9. The ruptured uterine wall could be repaired by suturing. To our knowledge, this is the first case report of uterine rupture during pregnancy after resection of an adenomatoid tumor in the uterine body.