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Clinical vignette
Published online: 2022-08-11
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A case of successful delivery after IVF-ET in a patient with a history of full-thickness uterine rupture and subsequent reconstructive surgery

Monika Baczkowska1, Artur Skowyra1, Michal Ciebiera1
DOI: 10.5603/GP.a2022.0072
·
Pubmed: 35984344
Affiliations
  1. 2nd Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland, Poland

open access

Ahead of Print
CLINICAL VIGNETTES
Published online: 2022-08-11

Abstract

Uterine rupture is a full-thickness uterine wall defect occurring during pregnancy. It is a rare but life-threatening condition for both the mother and the newborn. Myomectomy is a common gynecological procedure performed due to symptomatic uterine fibroids. The incidence of uterine rupture after myomectomy is estimated at < 1%. Our patient underwent laparoscopic myomectomy as a part of infertility treatment. After several unsuccessful IVF-ET attempts and dietary treatment a spontaneous pregnancy was confirmed in the patient. The pregnancy was uneventful until 36 weeks of pregnancy when the patient presented at the emergency department with abdominal pain. Emergency laparotomy was performed exposing extensive uterine rupture. The child did not survive, but, fortunately, uterus-sparing surgery was successful. Afterwards, due to the thinning of the uterine wall at the site of the postoperative scar, a reconstructive surgery was performed, resulting in a properly healed uterus six months after surgery. During the subsequent pregnancy the patient was admitted to the hospital at the 32nd week of pregnancy and an elective cesarean section was performed at 36 weeks of pregnancy. A healthy girl was born. The presented case draws attention to the importance of careful qualification for uterine surgeries in women of reproductive age and proper informing about the possible complications, as pregnancies after uterine surgeries come with new management challenges. Nonetheless, appropriate care may lead to the birth of a healthy child and delighted parents.

Abstract

Uterine rupture is a full-thickness uterine wall defect occurring during pregnancy. It is a rare but life-threatening condition for both the mother and the newborn. Myomectomy is a common gynecological procedure performed due to symptomatic uterine fibroids. The incidence of uterine rupture after myomectomy is estimated at < 1%. Our patient underwent laparoscopic myomectomy as a part of infertility treatment. After several unsuccessful IVF-ET attempts and dietary treatment a spontaneous pregnancy was confirmed in the patient. The pregnancy was uneventful until 36 weeks of pregnancy when the patient presented at the emergency department with abdominal pain. Emergency laparotomy was performed exposing extensive uterine rupture. The child did not survive, but, fortunately, uterus-sparing surgery was successful. Afterwards, due to the thinning of the uterine wall at the site of the postoperative scar, a reconstructive surgery was performed, resulting in a properly healed uterus six months after surgery. During the subsequent pregnancy the patient was admitted to the hospital at the 32nd week of pregnancy and an elective cesarean section was performed at 36 weeks of pregnancy. A healthy girl was born. The presented case draws attention to the importance of careful qualification for uterine surgeries in women of reproductive age and proper informing about the possible complications, as pregnancies after uterine surgeries come with new management challenges. Nonetheless, appropriate care may lead to the birth of a healthy child and delighted parents.

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Keywords

uterine rupture; infertility; IVF-ET; myomectomy

About this article
Title

A case of successful delivery after IVF-ET in a patient with a history of full-thickness uterine rupture and subsequent reconstructive surgery

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Clinical vignette

Published online

2022-08-11

Page views

273

Article views/downloads

186

DOI

10.5603/GP.a2022.0072

Pubmed

35984344

Keywords

uterine rupture
infertility
IVF-ET
myomectomy

Authors

Monika Baczkowska
Artur Skowyra
Michal Ciebiera

References (5)
  1. Pop L, Suciu ID, Oprescu D, et al. Patency of uterine wall in pregnancies following assisted and spontaneous conception with antecedent laparoscopic and abdominal myomectomies - a difficult case and systematic review. J Matern Fetal Neonatal Med. 2019; 32(13): 2241–2248.
  2. Al-Zirqi I, Daltveit AK, Vangen S, et al. Risk factors for complete uterine rupture. Am J Obstet Gynecol. 2017; 216(2): 165.e1–165.e8.
  3. Yan L, Ding L, Li C, et al. Effect of fibroids not distorting the endometrial cavity on the outcome of in vitro fertilization treatment: a retrospective cohort study. Fertil Steril. 2014; 101(3): 716–721.
  4. Margueritte F, Adam C, Fauconnier A, et al. Time to conceive after myomectomy: should we advise a minimum time interval? A systematic review. Reprod Biomed Online. 2021; 43(3): 543–552.
  5. Yazawa H, Takiguchi K, Ito F, et al. Uterine rupture at 33rd week of gestation after laparoscopic myomectomy with signs of fetal distress. A case report and review of literature. Taiwan J Obstet Gynecol. 2018; 57(2): 304–310.

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