The Use of Laparoscopy for Suspected Postpartum Uterine Rupture: Changing the Paradigm.

Abstract

<h3>Study Objective</h3> To investigate the feasibility of laparoscopy as both diagnostic and operative tool in patients with suspected postpartum uterine rupture. <h3>Design</h3> Case series. <h3>Setting</h3> Tertiary university-affiliated hospital. <h3>Patients or Participants</h3> Sixteen women who were diagnosed with postpartum uterine rupture Between November 2012 and April 2021. <h3>Interventions</h3> Emergent laparoscopy or laparotomy in women with suspected post-partum uterine rupture. <h3>Measurements and Main Results</h3> Clinical and demographic data were retrospectively collected and analyzed. During the study period 7 women (43.7%) underwent laparoscopy and 9 women (56.2%) laparotomy for suspected postpartum uterine rupture. There where five cases of uterine rupture in the laparoscopy group and 9 cases in the laparotomy group all of which had the uterine defect sutured. There was no difference in hemodynamic parameters between the two groups. The median time interval from delivery to surgery was 66(IQR 39.5-187.5) minutes in the laparotomy group and 202(IQR 70-485) minutes in the laparoscopy group. The median operative time for laparoscopic surgery was 80(IQR 60-114) minutes and 73(IQR 58-101.5) minutes for the laparotomy group. Three women who underwent laparotomy (33.3%) and one who underwent laparoscopy (14.2%) were admitted to the intensive care unit following surgery. Blood transfusion was required in five women who had laparotomy (55.5%) and one who had laparoscopy (14.2%). Hospitalization period was longer in women who had laparotomy (median (IQR) of 5(4-5) days vs. 3(3-4)). There were no conversions to laparotomy in the laparoscopy group. <h3>Conclusion</h3> In careful patient selection and surgical expertise laparoscopic surgery for suspected postpartum uterine rupture is feasible and safe. It has the benefit of shorter recovery and early mobilization which is paramount important in women following delivery.