Uterine Rupture after Laparoscopic Myomectomy in Two Cases: Real Complication or Malpractice?

Antonella Vimercati,Annarosa Chincoli,Antonio Malvasi,Vittoria Del Vecchio,Ettore Cicinelli

doi:10.1155/2017/1404815

Abstract

We describe two cases of uterine rupture in pregnancy after laparoscopic myomectomy and analyze all the aetiological factors involved in this circumstance according to the recent literature, focusing above all on the surgical procedures and the characteristics of the excised myomas. The two cases of uterine rupture in pregnancy following laparoscopic myomectomy occurred at 36 and 18 weeks of gestation, respectively. Both women had undergone laparoscopic multiple myomectomy and uterine rupture occurred along the isthmic myomectomy scars, despite the fact that compliance with all the recent technical surgical recommendations for the previous laparoscopic multiple myomectomy had been fully observed. In our cases we identified the isthmic localization, size of the excised myomas (≥4 cm), and individual characteristics of the healing process as possible risk factors for “a real complication.” Larger studies and robust case-control analyses are needed to draw reliable conclusions; special care should be paid when performing laparoscopic myomectomy in women planning a later pregnancy.

Highlights

Uterine rupture in pregnancy is a rare and often catastrophic complication with a high incidence of fetal and maternal morbidity and mortality
It may occur in an unscarred uterus, the most common cause of uterine rupture is splitting of a previous cesarean scar
Several aetiological factors may be responsible for rupture of the uterus, including previous cesarean section or laparotomic/laparoscopic adenomyomectomy, trauma, uterine overdistension, uterine anomalies, placenta percreta, and choriocarcinoma [11, 12]

Summary

Introduction

Uterine rupture in pregnancy is a rare and often catastrophic complication with a high incidence of fetal and maternal morbidity and mortality. Uterine rupture refers to a complete separation of all the uterine layers [7] and of the overlying visceral peritoneum and is often associated with clinically significant paroxysmal pain, uterine bleeding, fetal distress, and even protrusion or expulsion of the fetus and/or placenta into the abdominal cavity It entails the need for prompt cesarean delivery, uterine repair, or hysterectomy. Several aetiological factors have been identified, and here we report our experience of two cases of uterine rupture after previous laparoscopic myomectomy, focusing on the characteristics of the surgery, and the type, localization, and size of the fibroids In this regard, the new US classification of myomas, MUSA 2015 (morphological uterus sonographic assessment; [8, 9]) introduced to define and standardize US imaging of uterus fibroids, could be useful to better correlate the localization and characteristics of myoma before laparoscopy and reduce the risk of rupture in pregnancy.

Cases Presentation

Findings

Discussion