Uterine rupture in labor following perforation during operative hysteroscopy-a case report and review of literature

Abstract

Background: Hysteroscopic surgeries have become the standard treatment for uterine septa, synechiae, submucous myomas and endometrial polyps. It is considered a safe procedure: the incidence of surgical complications, including uterine perforation, is low (0.95% - 2.7%). Uterine rupture secondary to operative hysteroscopy is rare but potentially catastrophic. It can occur both before the onset of labor or during labor, severely compromising fetal and maternal outcomes. An operative hysteroscopy for retained placenta done one month after a normal vaginal delivery was complicated by a fundal uterine perforation whilst the removal of the abnormal tissue. The perforation was assessed laparoscopically and minimal bleeding was electrocoagulated. The patient was counseled that this complication should not affect future deliveries. In her subsequent pregnancy, an emergency cesarean hysterectomy was performed during advanced labor due to cornua-to-cornua fundal uterine rupture. Conclusion: There are many potential risk factors for uterine rupture in pregnancy. While previous cesarean delivery is the most well-known, prior complex hysteroscopy appears to also be a risk factor. While the exact relative risk is still unclear we feel that patients undergoing hysteroscopy for uterine septum and cases complicated by fundal uterine perforation during hysteroscopy must be informed about the risk of future uterine rupture, both during labor and during pregnancy. Out: We then summarize previous literature regarding hysteroscopy and uterine rupture focusing on risk factors such as surgery for uterine septum, use of electrocautery and uterine perforation. The Time interval between hysteroscopy and pregnancy does not appear to be a risk factor. Precis: Operative hysteroscopy complicated by fundal uterine perforation is a risk factor for uterine rupture both during pregnancy and labor.