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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


- 2nd Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland, Poland
open access
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.
Keywords
uterine rupture; infertility; IVF-ET; myomectomy


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
Issue
Article type
Clinical vignette
Published online
2022-08-11
Page views
273
Article views/downloads
186
DOI
10.5603/GP.a2022.0072
Pubmed
Keywords
uterine rupture
infertility
IVF-ET
myomectomy
Authors
Monika Baczkowska
Artur Skowyra
Michal Ciebiera


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