Fertility-preserving Surgery Research Articles

Growing teratoma syndrome after surgery for ovarian immature teratoma

Growing teratoma syndrome (GTS) is a condition characterized by tumor growth during or after chemotherapy for a germ cell tumor, albeit with normal tumor marker levels in the absence of histopathological evidence of immature teratoma components. We encountered a 10-cm large GTS lesion in the para-aorti nodes after fertility-preserving surgery for a grade 3 ovarian immature teratoma. The patient was a 20 year old woman who presented to the hospital with complaints of abdominal pain and swelling. Imaging examination revealed an ovarian tumor mass measuring 24 cm in the abdominal cavity, suspected to be composed of a mixture of fat and other components. The α-fetoprotein (AFP) levels were elevated at 853 ng/mL. We elected to perform fertility-preserving surgery. The surgical findings included a tumor in the right ovary, which was excised without rupture with adnexectomy. The histopathological diagnosis was grade 3 immature teratoma. Palpation of the pelvic and para-aortic lymph node areas did not reveal significant lymphadenopathy. Subsequently, a para-aortic node metastasis (major axis: 8 cm) was discovered before chemotherapy (19 days after surgery). We confirmed that there was no swelling before surgery and assumed that the immature teratoma had recurred. Chemotherapy was initiated, and the serum AFP levels normalized after 4 courses of bleomycin, etoposide, and cisplatin (BEP) therapy. However, the para-aortic node metastasis had grown further (major axis: 10 cm). Another open surgery was performed. The nodal mass was completely excised and pathology revealed only mature teratoma. Growing teratoma syndrome should be considered in the setting of a recurrent mass with negative tumor markers.

Prognostic Factors of Granulosa Cell Tumors: A Retrospective Study in a Tertiary Care Cancer Centre of Eastern India.

Bhagyalaxmi NayakBackground and Aims The main objective of this study was to analyze the clinicopathological profile and prognostic factors of granulosa cell tumor (GCT). Method All the cases of ovarian cancer which were seen at our institute between January 2000 and December 2017 were reviewed. Data were analyzed with failure-free survival (FFS) as the primary end point. Results GCTs consisted of 2.66% of all ovarian cancers at our institute. The median age was 43 years. Majority of the patients (62.5%) were unstaged. Six patients (25%) had a fertility-preserving procedure. Forty two percent of the patients received adjuvant chemotherapy. Thirty eight percent of the patients developed recurrence. Considering tumor-related prognostic factors, there was a statistically significant decrease in FFS with the presence of hemorrhage ( p = < 0.001), larger tumors ( p = 0.042), and juvenile variant ( p = 0.002). On the contrary, when treatment-related factors were considered, there was no statistically significant improvement in FFS with the performance of lymphadenectomy ( p = 0.218), omentectomy ( p = 0.453), fertility sparing surgery ( p = 0.152), or administration of adjuvant chemotherapy ( p = 0.45). Conclusion Inherent tumor-related biological factors tend to play a more important role compared with treatment-related factors in GCTs. Hence, the traditional practice of performance of extensive staging procedures and routine adjuvant chemotherapy should be reviewed. Fertility-preserving surgery appears safe to be offered in early stages when desired. Although it is common knowledge that GCTs tend to be hemorrhagic tumors, this factor has not been well recognized as a prognostic indicator till date. Our study sheds some light on this aspect. Since these tumors have a tendency toward late recurrences, a long follow-up is prudent.

Fertility sparing surgery in malignant ovarian Germ cell tumor (MOGCT): 15\xa0years experiences

AimWe aim to evaluate the reproductive outcome of fertility-sparing surgery and chemotherapy among young women diagnosed with MOGCT of any stage.MethodsIn the current retrospective study we evaluated 79 patients with malignant ovarian germ cell tumors (MOGCT) who visited at Imam Center, Vali-e-asr Hospital, Gynecologic Oncology department during 2001–2016. Reproductive outcomes (menstruation status and childbearing) followed fertility-preserving surgery and adjuvant chemotherapy by filling questionnaires. Statistical analysis was done with SPSS software, Chi-Square Tests were done, and significance was determined at P ≤ 0.05. Results among 79 young women who underwent fertility-sparing treatment, 72 patients followed up for reproductive outcome, and 7 patients excluded because of death (3 cases), XY genotyping (3 cases), and bilateral ovarian involvement (1 case). The mean age at presentation was 23 years. (Range: 19–33 years). The 5 and 10-year disease-free survival rate was 87% and 94.4%, respectively. The overall survival rate (OSR) was 94.4% at 5 and 10 years. Regular menstruation recovered in 60 of 72 patients after treatment (83%). All patients without adjuvant chemotherapy experienced regular menstruation, while normal menstruation was retrieved in 78% in the adjuvant chemotherapy group at the end of treatment. This retrieval of regular menstruation was not dependent on the age or number of chemotherapy cycles. 19 of 26 patients who attempted pregnancy were led to delivery (73%). No one required infertility treatments. The mean of chemotherapy cycles is related to a successful pregnancy.ConclusionWe showed patients with MOGCT could become pregnant and give birth if they desire. The advanced tumor stage wasn't the convincing factor for avoiding fertility preservation. Fertility sparing surgery with adjuvant chemotherapy is a safe treatment and results in a high fertility rate.

The value of fertility-sparing surgery for young females with epithelial ovarian cancer: a comparative study

Background: Epithelial ovarian cancer is increasingly often diagnosed in young females who wish to preserve their fertility. Fertilitypreserving surgeries, where conservation of the uterus and contralateral ovary was performed, might be beneficial for patients with stage I epithelial ovarian cancer, but their safety is still controversial. In the present study, we aimed to compare radical surgery and fertility-saving surgery in females with stage IA–C epithelial ovarian cancer for recurrence and survival rates, as well as to evaluate reproductive and obstetric outcomes for stage I epithelial ovarian cancer females who were managed with fertility-saving surgery. Materials and methods: We prospectively identified 60 patients aged ≤40 years who were diagnosed with stage I epithelial ovarian cancer. The patients in the fertility-preservation group underwent salpingo-oophorectomy on the side of the affected ovary in addition to incisional biopsy or wedge excision of the ovary on the other side. The patients in the radical surgery group underwent total hysterectomy and bilateral salpingo-oophorectomy. We followed up all patients for 5 years to assess their reproductive and oncological outcomes. Results: Patients in the fertility preservation surgery group were significantly younger (30 ± 4 versus 35 ± 5 years) (p &lt; 0.001), their tumor sizes were smaller (3.4 ± 1.3 versus 6.0 ± 2.6 cm) (p &lt; 0.001), of lower grade (p = 0.011), earlier stage (p &lt; 0.001) and had more mucinous histology than patients in the radical surgery group. There were no statistically significant differences between both groups regarding tumor recurrence or survival rates. Of 25 patients who underwent fertility preservation surgery, 18 (72%) attempted to conceive. A total of 15/18 (83%) pregnancies were recorded, including 13 live births, 1 miscarriage, and 1 intrauterine fetal death. Conclusion: Fertility-sparing surgery could be an adequate alternative to radical surgery for young females with stage I epithelial ovarian cancer.

Trends over time in the incidence and use of hormonal therapy in endometrial cancer: a population-based study in the Netherlands

IntroductionAccording to current guidelines, hormonal therapy may be applied in endometrioid type endometrial cancer as an alternative to surgery for fertility preservation and in medically unfit patients. Since it is...

The impact on obstetric outcomes following complete amputation of the cervix uteri in fertility preservation surgery for cervical neoplasm

ObjectivesRadical trachelectomy is offered to women with early-stage cervical neoplasia who desire fertility. The presence of isthmic glands within histological specimens suggests complete cervical amputation and as such, we examined if the presence of these glands in surgical specimens adversely affects obstetric outcomes. Study DesignThe study cohort comprises 43 consecutive cases of early-stage cervical neoplasia. The presence of isthmic glands in pathological specimens was correlated with obstetric outcomes. Univariate and multivariate analyses were constructed to identify clinicopathological factors associated with adverse obstetric outcomes. Results43 patients underwent fertility sparing surgery; radical (30; 69.8 %) or simple trachelectomy (13; 30.2 %). Of these, 26 (60.5 %) had isthmic glands within the surgical specimen. Isthmic gland presence was not influenced by surgery radicality, disease stage, histological diagnosis, or surgical approach. Obstetric outcomes were available for 36 patients, with 27 attempting conception post-trachelectomy and 15 (55.6 %) achieving at least one pregnancy. Of 21 total pregnancies, the miscarriage and live birth rates were 7.4 % and 85.0 %, respectively. The presence of isthmic glands did not influence the overall conception rate, with 53.8 % of women with complete cervical amputation conceiving compared to 57.1 % of those without (p = 0.8632). Complete removal of the cervix did not increase premature deliveries <37 weeks gestation (p = 0.2521). ConclusionsThe presence of isthmic glands in trachelectomy specimens provides a reliable surrogate marker for complete cervical amputation. In cases where complete cervical amputation is required to achieve maximum oncological outcomes, patients may be assured that there is little evident impact on fertility and obstetric outcomes.

Conservative Fertility-preserving Surgery in a Woman with Huge Adenomyosis using Triple Flap Technique and Mirena: A Case Report

Conservative Fertility-preserving Surgery in a Woman with Huge Adenomyosis using Triple Flap Technique and Mirena: A Case Report

Fertility preserving surgery in carcinoma ovary: a single institution experience

Conventional treatment of ovarian cancer includes removal of the uterus and both ovaries. Use of fertility preservation surgery (FPS) has been steadily rising due to late marriages/ pregnancy combined with an increase in the number of patients diagnosed with early stage ovarian cancer. We present our series of ovarian cancer patients in whom FPS was done. We retrospectively analyzed cases of ovarian cancer in which FPS was carried out between 2011 to 2017 at our hospital. All patients diagnosed with ovarian cancer stage I-III who underwent comprehensive surgical staging and in whom the uterus and contralateral ovary was preserved either at laparoscopy or by open technique were included in the analysis. Thirty one patients (31) underwent FPS . The mean age was 23 years (range 11–33). Twenty three were operated upfront and 8 after neoadjuvant chemotherapy. Germ cell tumors (GCT’s) were the most common histology (17 patients) followed by epithelial ovarian cancers (8- invasive and 4 -borderline) only 2 patients had granulosa cell tumours. Amongst GCT’s, 4 were dysgerminomas and 13 non-dysgerminomatous tumors (6- immature teratomas, 3 yolk sac tumors and 4 mixed germ cell tumors). 24 patients were in stage IA, 2 in stage IC, 1 in stage IIB, 2 in stage IIIB and 2 in stage IIIC. After a median follow up of 40 months, 3 patients (9.6%) were lost to follow up. There were 4 recurrences; 2 patients were FIGO stage IA, one FIGO stage IC and the other was FIGO stage IIIB. None of them had grade 3 tumors. The overall survival was 92.85 % and recurrence free survival was 85%. Fourteen (14), (50%) patients were unmarried at the time of analysis and 7 of the remaining 14 patients already had a child and did not plan for another. Seven(7) patients planned to start their family, 2 patients (28.6%) conceived and both had full term normal pregnancy with live birth. Fertility-preserving surgery should be considered for young ovarian cancer patients who want to preserve their fertility. The decision regarding fertility preservation in higher stage (more than stage 1A) and high grade (grade 3) tumors should be taken only after adequate patient counseling regarding the risks of recurrence and chances of retaining fertility.

Fertility Preservation in Cancer Patients

Abstract Traditional radiotherapy and chemotherapy often cause irreversible damage to the fertility and endocrine function of cancer patients. The current methods of fertility preservation include freezing the sperms of adult and adolescent males after puberty; freezing the embryos, oocytes, and ovarian tissue of females; and drug intervention and fertility preservation surgery. This article reviews fertility preservation in cancer patients with respect to current methods, indications, and some more recently developed methods that remain under investigation.

Aktualny stan wiedzy i nowe doniesienia z zakresu chirurgii zachowującej płodność w wybranych schorzeniach onkoginekologicznych

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Kornovski Y, Ivanova Y, Kostov S, Slavchev S, Yordanov AD. Current state and new aspects of fertility preservation surgery in some oncogynaecological diseases. Medical Studies/Studia Medyczne. 2021;37(1):77-82. doi:10.5114/ms.2021.105005. APA Kornovski, Y., Ivanova, Y., Kostov, S., Slavchev, S., & Yordanov, A. (2021). Current state and new aspects of fertility preservation surgery in some oncogynaecological diseases. Medical Studies/Studia Medyczne, 37(1), 77-82. https://doi.org/10.5114/ms.2021.105005 Chicago Kornovski, Yavor, Yonka Ivanova, Stoyan Kostov, Stanislav Slavchev, and Angel D Yordanov. 2021. "Current state and new aspects of fertility preservation surgery in some oncogynaecological diseases". Medical Studies/Studia Medyczne 37 (1): 77-82. doi:10.5114/ms.2021.105005. Harvard Kornovski, Y., Ivanova, Y., Kostov, S., Slavchev, S., and Yordanov, A. (2021). Current state and new aspects of fertility preservation surgery in some oncogynaecological diseases. Medical Studies/Studia Medyczne, 37(1), pp.77-82. https://doi.org/10.5114/ms.2021.105005 MLA Kornovski, Yavor et al. "Current state and new aspects of fertility preservation surgery in some oncogynaecological diseases." Medical Studies/Studia Medyczne, vol. 37, no. 1, 2021, pp. 77-82. doi:10.5114/ms.2021.105005. Vancouver Kornovski Y, Ivanova Y, Kostov S, Slavchev S, Yordanov A. Current state and new aspects of fertility preservation surgery in some oncogynaecological diseases. Medical Studies/Studia Medyczne. 2021;37(1):77-82. doi:10.5114/ms.2021.105005.

Infertility in women with bowel endometriosis: first-line assisted reproductive technology results in satisfactory cumulative live-birth rates

To evaluate the assisted reproductive technology (ART) cumulative live-birth rate (LBR) in a cohort of bowel endometriosis patients with no prior history of surgery for endometriosis. Prospective cohort study. University hospital. One hundred and one consecutive infertile bowel-endometriosis patients with no prior history of surgery for endometriosis in whom the diagnosis of endometriosis was based on published imaging criteria using transvaginal sonography and magnetic resonance imaging. First-line ART. Cumulative LBR, with statistical analysis via Kaplan Meier method with a "conservative" method, whereby it was assumed that no live births took place for patients who did not return. Between January 2016 and December 2018, 101 bowel endometriosis patients underwent 176 ART cycles. The mean number of deep-infiltrating endometriosis lesions per patient was 3 ± 0.9, with a mean number of bowel lesions of 1.3 ± 0.6. Seventy-three percent of the patients had associated endometriomas, and 88.1% had associated adenomyosis. Overall, the cumulative LBR after four ART cycles was 64.4%, using the conservative Kaplan-Meier method. The ART cumulative LBR was very satisfactory (64.4%) in bowel endometriosis patients with no prior history of surgery for endometriosis. In light of these data, clinicians should carefully weigh the pros and cons before systematically referring infertile bowel endometriosis patients to fertility-preserving surgery because as first-line ART appears to offer satisfactory results.

STUDY OF OVARIAN MALIGNANCY IN GYNEONCOLOGY UNIT IN ELSHATBY HOSPITAL IN ALEXANDRIA AS A TERTIARY REFFERAL CENTER

Malignant ovarian neoplasms cause more deaths than any other cancer of the female genital tract and is the seventh most common cancer diagnosed.Staging for ovarian cancer is principally surgical and should include total abdominal hysterectomy with bilateral salpingo-oophorectomy, only unilateral adnexectomy in fertility preservation surgery, at least infra-colic omentectomy, multiple peritoneal biopsies, lymph node sampling including pelvic and para-aortic lymph nodes up to renal veins, peritoneal wash and appendectomy in case of suspicion of mucinous histology.During initial surgery, early stage ovarian cancer patients are often incompletely staged. This oversight can have unfavorable sequelae for the prognosis of such patients, as the completeness of surgical staging is an independent prognostic parameter for survival. The aim of this work was to retrospectively review patients with ovarian malignancy from period 2017-2019 in gyne-oncology department of Elshatby hospital.This retrospective study was conducted on records of women admitted to gyne-oncology department in Elshatby hospital during period from 1/6/2017 to 1/6/2019 diagnosed with ovarian malignancy.

Unilateral cystectomy and serous histology are associated with relapse in borderline ovarian tumor patients with fertility-sparing surgery: a systematic review and meta-analysis

Surgical procedures, histological subtypes, and surgical approaches are involved in the recurrence of borderline ovarian tumors (BOTs), but whether those three factors affect relapse remains controversial. This study aimed to explore the effects of surgical procedures, histological subtypes, and surgical approaches on the relapse and pregnancy rates of BOT after fertility-preserving surgery (FPS) according to the patients' characteristics. A systematic search of PubMed, Embase, and the Cochrane library was conducted from their inception to November 2018. Studies that investigated the impact of surgical procedures, histological subtypes, and surgical approaches on the relapse and pregnancy rates in patients with BOT after FPS were eligible. The pooled odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were calculated using the random-effects model. Thirty-five studies involving a total of 2921 patients with BOT after FPS were included. The pooled ORs indicated that the risk of relapse was significantly increased in patients who underwent unilateral cystectomy or with serous BOT. There was no significant difference between laparoscopy and laparotomy on the risk of relapse. Surgical procedures, histological subtypes, and surgical approaches did not influence pregnancy rates. Patients who underwent unilateral cystectomy or with serous BOT presented an excess risk of relapse after FPS, but the surgical approach did not affect the risk of relapse. The pregnancy rate is not affected by surgical procedures, histological subtypes, and surgical approaches.

Modification of Dargent’s radical vaginal trachelectomy to facilitate ureteral dissection: description of technique

ObjectiveRadical vaginal trachelectomy is the fertility-preserving surgery for patients with early stage cervical cancer. However, it has not gained widespread approval by gynecologic oncologists because of difficulties in the dissection...

Retrospective Analysis of Factors Affecting Recurrence in Borderline Ovarian Tumors.

Background Borderline ovarian tumors (BOTs) are an intermediate form of neoplasia, between benign and malignant. The aim of this retrospective analysis is to evaluate the clinicopathological characteristic profile of BOTs and to determine the predictors of recurrence in BOTs. Methods A retrospective review of all patients diagnosed, treated, and followed up for BOTs between 2010 and 2017 at Amrita Institute of Medical Sciences, Kerala, India, was conducted. Clinicopathological details and details of management, outcome, and survival were retrieved, and data were analyzed descriptively and for survival. Results A total of 103 patients were identified. During the median follow-up of 46.0 months, 15 (14.6%) patients developed recurrent disease, 6 (5.82%) had recurrence with progression to invasive carcinoma, and 9 had recurrent disease with borderline or benign histology. Mucinous tumors were found to have more recurrences than serous BOT (17.8 vs. 12.3%). Disease-related deaths (5/103 [4.9%]) were observed only in patients with progression to invasive carcinoma. Univariate analysis indicated that staging surgery was the most important prognostic factor that affected the disease-free survival ([DFS] 103 vs. 97 vs. 71 months, respectively, for complete staging vs. fertility-preserving staging vs. conservative surgery; p < 0.05). Conclusions Conservative surgery was associated with a higher risk of recurrence. Fertility-preserving staging surgery is an acceptable option in younger patients. The overall survival is not affected by the mode of surgery.

Clinical Characteristics and Treatment Outcomes of Patients with Ovarian Germ Cell Tumor Treated at a Tertiary Care Center in Patna, India

Ovarian germ cell tumors are rare tumors, mainly diagnosed in young females with a good prognosis if presented earlier. The objective of this study was to evaluate the clinicopathological features, treatment and outcome of the malignant ovarian germ cell tumors. We retrospectively reviewed 37 patients of malignant ovarian germ cell tumors registered at the Department of Radiation Oncology All India Institute of Medical Sciences (AIIMS), Patna, from August 2014 to September 2019, and analyzed their demographic profile, treatment, outcome and survival. The median age at presentation was 15 years with a median duration of symptoms of 18 weeks. Abdominal pain and abdominal pain with lump were the main presenting symptoms of 45.9% and 45.9%, respectively. The median pre-chemotherapy value of AFP was 286 ng/ml, βHCG was 8.2 mIU/ml, and LDH was 470 U/L. Fertility-preserving surgery was done in 64.9% of cases. 35.1%, 21.6%, 29.7% and 13.5% cases were in stage I, stage II, stage III and stage IV, respectively. Adjuvant systemic chemotherapy was indicated in 94.6%, and chemotherapy was not indicated in 5.4% of patients. Non-dysgerminoma was the most common histopathological type (67.7%) followed by mixed germ cell tumors and dysgerminoma in 18.9% and 13.5%, respectively. The mean follow-up duration was 40 months, 32.4% of patients developed recurrence, and mean time to recurrence was 25 months. Malignant ovarian germ cell tumor is a treatable disease, and selected patients may be managed with fertility-preserving surgery. It was observed in this study that malignant ovarian germ cell tumors have a good prognosis.

Simple vaginal trachelectomy in women with early-stage low-risk cervical cancer who wish to preserve fertility: the new standard of care?

ObjectiveThere is a trend toward less radical surgery in women with small-volume disease who wish to preserve fertility. The objective of our study was to evaluate the oncologic and obstetrical...

Retrospective Study of the Clinicopathological Characteristics of Adult Granulosa Cell Tumour of the Ovary at a Tertiary Care Centre

This retrospective analysis aimed to evaluate the clinicopathological characteristics of adult granulosa cell tumours (AGCT) treated at a tertiary care centre. Demographic, clinicopathological, treatment and follow-up details of all patients with AGCT treated from January, 2003 till July, 2014 were extracted from institutional cancer registry and Electronic Medical Records, after obtaining necessary clearance from institutional ethical committee, and institutional review board. The details obtained were tabulated and analyzed. Thirty-three patients were identified to have AGCT; 24 at initial diagnosis and nine at recurrence. Mean age at diagnosis among patients seen at initial diagnosis and those at recurrence was 50.42 years versus 40.78 years, while mean tumour size was 11.9 cm and 14.8 cm respectively. Abdominal pain was most common symptom at presentation. All patients had upfront surgery. Of the 24 cases seen initially, 16 had staging surgery; among whom six were second surgery, one in the fertility sparing group, and five in the non-sparing group. None were upstaged. Complete resection was feasible in all 16. Three cases had fertility preserving surgery. Among the patients who had staging surgery, 81.25% were stage I and the rest stage IIb. Six patients received postoperative chemotherapy. The mean follow-up period was 42.08 months. Mean time to relapse among the nine recurrent cases was 92.79 months. All patients had intra-abdominal recurrence, pelvis and omentum being the most common sites. Resection of metastatic sites was done in all nine cases. Three patients received preoperative chemotherapy and one received postoperative radiotherapy. The mean overall survival was 170.18 months. Complete resection of tumour is feasible both in primary and recurrent cases. Fertility preserving surgery may be offered to women with early-stage disease who opt to retain fertility. Long term follow-up with pelvic and whole abdominal surveillance is necessary.

Outcomes and prognostic factors of patients with recurrent and persistent malignant ovarian germ cell tumors.

Due to the rarity of recurrent and persistent malignant ovarian germ cell tumors (MOGCTs), there is no standardized protocol for salvage therapy. This study aimed to investigate the outcomes and prognostic factors of patients with recurrent and persistent MOGCTs. Clinical data for 59 patients with recurrent and persistent MOGCTs admitted to Peking Union Medical College Hospital from January 1, 2000, to April 30, 2018, were retrospectively analyzed. Twenty-one cases (35.6%) were recurrent, and 38 (64.4%) were persistent. Patient age ranged from 1 to 39years, and disease stage was as follows: 33 stage I, 4 stage II, 21 stage III, and 1 stage IV. There were 19 immature teratomas, 26 yolk sac tumors, 1 dysgerminoma, and 13 mixed germ cell tumors. Regarding the primary surgery, fertility was preserved in 49 patients and not preserved in 10 patients. Among the patients who underwent fertility-preserving primary surgery, 40 had fertility preserved in the second operation, and 9 did not. In the mean follow-up of 52.6months (range 2-279months) after recurrence, 19 patients (32.2%) experienced a second relapse, and 16 (27.1%) died. The 5-year survival and progression-free survival rates after relapse were 70.0% and 67.0%, respectively. The optimal salvage surgery and chemotherapy regimen after relapse were independent prognostic factors (P < 0.05). The prognosis of recurrent and persistent MOGCTs was good after salvage therapy. The optimal salvage surgery and adjuvant standardized chemotherapy significantly impact patient prognosis. For young nulliparous patients, secondary fertility-sparing salvage therapy can be considered.

Unscarred uterine rupture and subsequent pregnancy outcome - a tertiary centre experience.

The aim of this study was to investigate the incidence, etiology and obstetric outcomes of rupture in unscarred uterine rupture and in those with a history of uterine rupture MATERIAL AND METHODS: The hospital records of women who had delivered between May 2005 and May 2017 at a tertiary center were examined retrospectively. Data on patients with unscarred uterine rupture in pregnancy who had undergone fertility-preserving surgery were evaluated. During the study period, 185,609 deliveries occurred. Of those, unscarred uterine rupture has occurred in 67 women. There were no ruptures reported in nulliparous women. The rupture was observed in the isthmic region in 60 (89.6%) patients and in the fundus in 7 (10.4%) patients. Thirty-eight (56.7%) patients had undergone a total or subtotal hysterectomy, and 29 (43.3%) patients had received primary repair. Ten patients had reconceived after the repair. Of these, eight patients who had a history of isthmic rupture, successfully delivered by elective C-section at 36-37 wk. of gestation, and two experienced recurrent rupture at 33 and 34 wk. of gestation, respectively. Both patients had a history of fundal rupture, and their inter-pregnancy interval was 9 and 11 mo., respectively. The incidence of rupture in unscarred pregnant uteri was found to be one per 2,770 deliveries. Owing to the high morbidity, regarding more than half of the cases with rupture eventuated in hysterectomy, clinicians should be prudent in induction of labour for multiparous women since it was the main cause of rupture in this series. Short inter-pregnancy intervals and history of fundal rupture may confer a risk for rupture recurrence. Those risk factors for recurrence should be validated in another studies.