Journal Article•
Uterine rupture during pregnancy after laparoscopic myomectomy.
TL;DR: A 31 year old patient presenting with primary infertility underwent an operative laparoscopy for the treatment of bilateral hydrosalpinges, during which a myomectomy was also performed, which revealed a uterine rupture at the site of the previous myomextomy scar.
Abstract: A 31 year old patient presenting with primary infertility underwent an operative laparoscopy for the treatment of bilateral hydrosalpinges, during which a myomectomy was also performed. The uterus was repaired using interrupted sutures. At follow-up laparoscopy seven weeks later, a uterine fistula was diagnosed and was oversewn using a single 'figure of eight' suture. One year later the patient became pregnant through in-vitro fertilization. At 34 weeks gestation, she required an emergency laparotomy for acute abdominal pain and the presence of fetal bradycardia. The operative findings revealed a uterine rupture at the site of the previous myomectomy scar. This was then enlarged with a scalpel and a live baby was delivered. The uterus was repaired in two layers. The postoperative period for both mother and baby was satisfactory. This complication raises the problem of the quality of uterine repair following laparoscopic myomectomy, together with the question of how to prevent this type of life-threatening situation.
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TL;DR: Although uterine myomas presently are not well understood, many advances have been made in the understanding of the hormonal factors, genetic factors, growth factors, and molecular biology of these benign tumors.
604 citations
TL;DR: The purpose of this study was to compare, in infertile patients, the efficacy of laparoscopic myomectomy versus abdominal myomeCTomy, in restoring fertility and to evaluate the obstetric outcomes.
Abstract: The purpose of this study was to compare, in infertile patients, the efficacy of laparoscopic myomectomy versus abdominal myomectomy, in restoring fertility and to evaluate the obstetric outcomes. Between January 1993 and January 1998, 131 patients of reproductive age, with anamnesis of infertility, underwent myomectomy because of the presence of at least one large myoma (diameter greater than or = 5 cm). Patients were randomly selected for treatment by laparotomy (n = 65) or laparoscopy (n = 66). The two groups were homogeneous for number, size and position of large myomata. Significant differences were found in the post-operative outcome: febrile morbidity (> 38 degrees C) was more frequent in the abdominal than in the laparoscopic group (26.2 versus 12.1%; P < 0.05). Laparotomy caused a more pronounced haemoglobin drop (2.17 +/- 1.57 versus 1.33 +/- 1.23; P < 0.001); three patients received a blood transfusion after laparotomy and none after laparoscopy. The post-operative hospital stay was shorter in the laparoscopic group (142.80 +/- 34.60 versus 75.61 +/- 37.09 h; P < 0.001). No significant differences were found between the two groups as concerns pregnancy rate (55.9% after laparotomy, 53.6% after laparoscopy), abortion rate (12.1 versus 20%), preterm delivery (7.4 versus 5%) and the use of Caesarean section (77.8 versus 65%). No case of uterine rupture during pregnancy or labour was observed.
391 citations
TL;DR: The complication rate appears to be better than acceptable in comparison with complication rates reported after laparotomic myomectomies, and can be considered a safe technique with an extremely low failure rate and good results in terms of pregnancy outcome.
267 citations
TL;DR: Spontaneous uterine rupture seems to be rare after laparoscopic myomectomy (LM), which should not deter the use of LM if needed and particular care must be given to the uterine closure.
Abstract: Uterine rupture after myomectomy by laparotomy is not a common occurrence. Some case reports of uterine rupture after laparoscopic myomectomy (LM) raise the question of the quality of the uterine scar produced when this technique is performed. In order to assess the outcome of pregnancies and deliveries after LM and to assess the risk of uterine rupture, we performed an observational study. Questionnaires were mailed to all women who had had LM for at least one intramural or subserosal myoma of more than 20 mm diameter and who were aged <45 years. Ninety-eight patients became pregnant at least once after LM, giving a total of 145 pregnancies. Among the 100 patients who had delivery, there were three cases of spontaneous uterine rupture. Because only one of these uterine ruptures occurred on the LM scar, the risk of uterine rupture was 1.0% (95% CI 0.0-5. 5%). Seventy-two patients (72.0%) had trials of labour. Of these, 58 (80.6%) were delivered vaginally. There was no uterine rupture during the trials of labour. Spontaneous uterine rupture seems to be rare after LM. This risk should not deter the use of LM if needed. When performing LM, particular care must be given to the uterine closure.
262 citations
Cites background or methods from "Uterine rupture during pregnancy af..."
...This case has been reported previously Table VI. Appearance of uterine scars at second-look laparoscopy and(Dubuisson et al., 1995). during Caesarean section (n 7) Case no. 2 was a woman aged 34 years who underwent LM for the ablation of two myomas, one of which was a sessile Caesarean section…...
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...…and the fact that uterine rupture took place in a different institution reported after myolysis confirm this negative effect of electrocoagulation (Arcangeli and Pasquarette, 1997; Vilos et al., 1998).to ours (Dubuisson et al., 1995), means it is unlikely that we missed another uterine rupture....
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...It may be an advantage to assess the quality of the scars postoperatively in order to decide on the typeof uterine rupture after LM (Table I) (Harris, 1992; Dubuisson et al., 1995; Mecke et al., 1995; Friedmann et al., 1996; Pelosi of birth....
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...%) received oxytocin augmen- Our study covers the largest series of pregnancies after LM to an adverse effect on healing (Harris, 1992; Dubuisson et al., 1995; Pelosi and Pelosi, 1997)....
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TL;DR: Advances in surgical instruments and techniques are expanding the role of laparoscopic myomectomy in well-selected individuals, and meticulous repair of the myometrium is essential for women considering pregnancy after laparoscopy to minimize the risk of uterine rupture.
223 citations