Recurrent uterine rupture after hysterescopic resection of the uterine septum

Abstract

a b s t r a c t INTRODUCTION: Uterine rupture after hysteroscopic septum resection is a rare complication, and its frequency is reported to be approximately 1-2.7%. Uterine perforation and monopolar resection during hysteroscopy are well-known risk factors for subsequent uterine rupture during pregnancy. PRESENTATION OF CASE:We present a case of recurrent uterine ruptures during consecutive pregnancies in a patient who had undergone hysteroscopic septum resection for recurrent pregnancy loss. DISCUSSION: Recurrent uterine rupture due to hysteroscopic septum resection in pregnancy is a very rare condition. In the present case we noted that the first two uterine ruptures resulted from uterine contractions; however, the third rupture occurred spontaneously and earlier in gestation. As each uterine rupture occurred earlier than the rupture in the previous gestation, a history of uterine rupture during pregnancy should raise provider suspicion about the possibility of earlier uterine rupture recurrence. CONCLUSION: Uterine rupture may occur in pregnancies after hysteroscopic resection of the uterine septum. However, if a patient has a history of uterine rupture during previous pregnancies, the risk of uterine rupture may increase for earlier gestational ages in subsequent pregnancies. The patient must be informed about both the risks of uterine rupture during pregnancy after hysteroscopic septum resection and that recurrent ruptures may occur at earlier gestational weeks than during previous pregnancies.

A womb like a broken heart

“…Roy et al described a uterine perforation rate of 1.2% with a caesarean section rate of 43.2% for obstetric reasons 6. Ergenoglu et al described a case of recurrent uterine ruptures in consecutive pregnancies in a patient who had undergone septal resection for recurrent abortions, each occurring earlier in gestation than the previous, causing fetal loss and considerable maternal morbidity 7. Senthilles et al analysed 14 case reports in the literature describing uterine rupture after operative hysteroscopy, with uterine perforation occurring in eight of the cases and electrosurgery used in nine case 1.…”

Spontaneous uterine rupture at 14 weeks gestation during a pregnancy consecutive to an oocyte donation in a woman with Turner's syndrome

“…Spontaneous preterm uterine rupture is very rare [1,2,4,5,[13][14][15][16]. In vitro fertilization (IVF) is known to raise the risk of cornual pregnancy and placenta anomalies.…”

Hysteroscopy and pain: what risk factors should we consider in office hysteroscopy? are there really any?

“…Hysteroscopy as a routine technique is recent, but it all started in 1967 when Fritz Menken used a pediatric cystoscope to examine the womb, 1 allowing direct visualization 2 and diagnosis. [3][4][5][6] It is now a day considered the gold standard in investigating uterine abnormal bleeding. [7][8][9][10] Examinations and even operations are performed without anesthesia using Office Hysteroscopy (OH) and it is becoming increasingly popular; modern minihysteroscopes are slenderer (outer sheet between 3.1 and 3.6 mm) as opposed to "conventional" hysteroscopes (outer sheet of 5mm diameter) and therefor avoid cervical dilation.…”