Pregnancy After a Laparoscopic Sacrohysteropexy: a Case Report

Abstract

Introduction !Pelvic Organ Prolapse (POP) is a disorder which affects millions of women worldwide [1]. POP is a condition that can negatively impact on the quality of life for patients because this condition often coexists with pelvic floor disorders like urinary or faecal incontinence [2]. If conservative treatments have failed, the surgical procedure has proven to be a good way to cure this condition with a high efficacy rate and very low rates of both mortality and morbidity [3]. The usual treatment for a utero-vaginal prolapse is a hysterectomy followed by pelvic support repair [4][5]. In young women suffering from POP, who are at childbearing age, the type of surgical approach is currently unclear. Studies have proven that young women are at high risk of a POP recurrence after surgical treatment but so far no studies have evaluated the impact of surgical POP repair on subsequent pregnancies and types of delivery [6]. This article describes the case of a woman who had an unproblematic pregnancy and delivered without incident 13 months after a laparoscopic sacrohysteropexy. The concerning literature is reviewed and summarized.Case ! A 33-year-old IV-gravida, III-para was referred to our hospital at 38 4/7 weeks of gestation for an elective caesarean section due to foetal breech presentation and history of POP repair. Her obstetrical history consisted of two uneventful vaginal deliveries and a forceps extraction. Thirteen Abstract ! Pelvic Organ Prolapse (POP) is a rare condition during pregnancy. If all conservative treatments fail, the surgical approach has proven to be in non-pregnant women a very good option due to high efficacy and a very low morbidity and mortality rate. We are reporting on the clinical results of a 33-year-old pregnant woman with a past history of laparoscopic sacrohysteropexy who delivered by caesarean section due to a foetal breech presentation. There are only a handful of cases reporting the outcome "pregnancy" after a laparoscopic sacrohysteropexy. Nevertheless, this appears to be a useful intervention for women with a POP unresponsive to conservative treatment and open family planning. Further studies with long-term follow-ups are required to confirm this. Zusammenfassung

Outcomes of Pregnancy and Recurrence of Pelvic Organ Prolapse After Laparoscopic Sacrocolpopexy With Uterine Preservation: A Retrospective Case-Series Study

“…Furthermore, all patients except one were delivered in the same institute; therefore, data on the antenatal and operative records and fetal outcomes were available. Very few studies have previously reported pregnancy outcomes and recurrence risk of prolapse after laparoscopic SCP [ 2 , 7 - 9 ]. Different surgical techniques have been used in each study; three studies reported using a single mesh posterior to the cervix [ 2 , 9 , 10 ], one used anterior and posterior meshes [ 10 ], and one used a technique similar to ours, i.e., a mesh wrapped around the cervix [ 8 ].…”

Successful Pregnancy Outcome After Laparoscopic Sacrohysteropexy for Pelvic Organ Prolapse

“…The follow-up study was uneventful in most of the above cases except a case reported by Lewis et al, recurrence of POP after two years of delivery occurred and later managed by robotic-assisted laparoscopic supracervical hysterectomy, sacrocolpopexy, and perineorrhaphy [ 12 , 15 ]. With limited data, it is difficult to predict whether the recurrence was due to pregnancy or other underlying factors [ 16 ]. Keeping these cases in mind, all women who plan for pregnancy after surgical repair of POP should be counseled properly about the chances of recurrent prolapse and safety concerns during pregnancy.…”

“…Cesarean section was the preferred method of delivery among all available literature as it is logical to avoid disruption of reconstructed support [ 16 ]. Because of very limited data, it is not possible to make recommendations regarding the mode of delivery after surgery for pelvic organ prolapse [ 13 ].…”

Pregnancy management in laparoscopic promontofixation patients: a challenging situation with no clear recommendations

“…Due to demographic changes, there is a growing trend of POP in women of childbearing age [ 2 ], so, many patients desire definitive surgical management prior to family completion. Many techniques have been described for the surgical treatment of POP whether vaginally, abdominally or laparoscopically exist in the literature [ 3 ], but little is published on subsequent pregnancy [ 4 ].…”