The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis

Claeys, Jana; Hellendoorn, Inez; Hamerlynck, Tjalina; Bosteels, Jan; Weyers, Steven

doi:10.1007/s10397-014-0842-8

Cited by 69 publications

(58 citation statements)

References 47 publications

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“…The impact on the mother and her fetus is also very diverse. The risk of uterine rupture by LSM was reported to be about 0.6% [8] and was similar to that of LTM [9]. In our 14 case series, the number of uterine rupture cases after LSM were 8 (8/14, 57%).…”

Section: Discussionsupporting

confidence: 68%

“…In addition, neonatal mortality related to uterine rupture occurred in 33%. These studies asserted that myomectomy for women of reproductive age could be relatively safe [9]. However, the incidence of uterine rupture may vary in function of the size, type, and location of the myoma, in addition to the suture technique used for myomectomy, and the interval of subsequent pregnancy and myomectomy [1011].…”

Section: Introductionmentioning

confidence: 99%

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Uterine rupture in pregnancies following myomectomy: A multicenter case series

Kim

Choi

et al. 2016

Obstet Gynecol Sci

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ObjectiveThe purpose of this case series was to retrospectively examine records of cases with uterine rupture in pregnancies following myomectomy and to describe the clinical features and pregnancy outcomes.MethodsThis study was conducted as a multicenter case series. The patient databases at 7 tertiary hospitals were queried. Records of patients with a diagnosis of uterine rupture in the pregnancy following myomectomy between January 2012 and December 2014 were retrospectively collected. The uterine rupture cases enrolled in this study were defined as follows: through-and-through uterine rupture or tear of the uterine muscle and serosa, occurrence from 24+0 to 41+6 weeks’ gestation, singleton pregnancy, and previous laparoscopic myomectomy (LSM) or laparotomic myomectomy (LTM) status.ResultsFourteen pregnant women experienced uterine rupture during their pregnancy after LSM or LTM. Preterm delivery of less than 34 weeks’ gestation occurred in 5 cases, while intrauterine fetal death occurred in 3, and 3 cases had fetal distress. Of the 14 uterine rupture cases, none occurred during labor. All mothers survived and had no sequelae, unlike the perinatal outcomes, although they were receiving blood transfusion or treatment for uterine artery embolization because of uterine atony or massive hemorrhage.ConclusionIn women of childbearing age who are scheduled to undergo LTM or LSM, the potential risk of uterine rupture on subsequent pregnancy should be explained before surgery. Pregnancy in women after myomectomy should be carefully observed, and they should be adequately counseled during this period.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Uterine rupture in pregnancies following myomectomy: A multicenter case series

Kim

Choi

et al. 2016

Obstet Gynecol Sci

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“…The risk of rupture is greatest in patients with a previous history of uterine surgery, including cesarean section or myomectomy, and extremely low in those with intact and unscarred uterus [1,2,3,4]. Possible causes of uterine rupture in the latter group include e.g.…”

Section: Resultsmentioning

confidence: 99%

“…The overall incidence of uterine rupture is approximately 0.04-0.09% in the general population, and women with a previous history of uterine surgery, including cesarean section or myomectomy, are considered the highest-risk group [1,2,3,4]. Few reports suggests there is an association between uterine rupture during pregnancy with previously performed salpingectomy.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Rupture of the Pregnant Uterus following Salpingectomy: A Literature Review

Stanirowski

Trojanowski

Słomka

et al. 2015

Gynecol Obstet Invest

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Background: Spontaneous rupture of the uterus is a life-threatening obstetric complication in rare cases associated with previously performed salpingectomy. Aim: This paper presents an analysis of uterine rupture cases during pregnancy in patients after surgical removal of the fallopian tubes. Methods: The English and Polish language literature was reviewed for studies published between January 1, 1980 and September 30, 2014 to identify articles that described rupture of the uterus in women with a previous history of salpingectomy. Results: Thirteen case reports and case series studies in 18 women were identified. 33% of cases of uterine rupture following salpingectomy occurred during intrauterine pregnancy, whereas the rest was associated with interstitial ectopic pregnancy. Laparoscopic salpingectomy more often resulted in rupture of the uterus during non-ectopic pregnancy as compared to laparotomy (4 vs. 2 cases, respectively). When interstitial pregnancies were excluded, uterine rupture was a cause of fetal death in 67% of reported gestations. There were no cases of maternal mortality. Conservative treatment was the preferred management option, and total hysterectomy was performed in only 2 patients. Conclusion: Particular attention should be paid to patients with a previous history of salpingectomy due to the risk of uterine rupture throughout the entire pregnancy.

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“…Based on the available evidence, there is no statically significant difference between the incidence of scar rupture during pregnancy following a laparoscopic versus an open myomectomy. 11 In selected cases, LM has been reported to be an effective technique that is associated with a low rate of patient morbidity (Dubuisson et al, 1996).…”

Section: Laparoscopic Myomectomy -Uterine Scar Dehiscence /Rupturementioning

confidence: 99%

Successful outcome of a triplet pregnancy following laparoscopic myomectomy for infertility: a unique case report

Hymavathi¹,

Tadisetti²,

Gottipati³

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Infertility is a burning problem affecting 10-15% of the couples globally. The female factors contribute to about 40- 45% among which uterine factor is up to 10%. Presence of uterine myomas also significantly contribute to infertility. A conservative surgical approach like myomectomy is indicated for women in reproductive age both for psychological reasons as well as to preserve their reproductive potential. In recent years laparoscopic myomectomy (LM) has become the procedure of choice. Pregnancy outcome after myomectomy is a more significant concern especially with regard to the obstetric calamity of sudden uterine rupture due to the presence of an operative scar. The intensity of such complication will be considerably high when a triplet pregnancy occurs with a LM scar in the upper uterine segment with history of uterine cavity being opened during the myomectomy surgery. Managing such a case will be a difficult task to the attending clinician posing many unexpected clinical dilemmas. We are reporting a unique case of triplet pregnancy occurred following a LM resulting in successful maternal and fetal outcome. During the course of this pregnancy apart from considerable maternal distress due to uterine over distension many clinical problems like cervical insufficiency, pre eclampsia, polyhydraminos, intrauterine growth restriction (IUGR) and last but not the least severe postpartum haemorrhage (PPH) have been encountered and could be managed efficiently. An elective Caesarean section was performed at 33+4 weeks gestation delivering live triplets. Mother and all the three babies discharged from the hospital in good condition.

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The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis

Cited by 69 publications

References 47 publications

Uterine rupture in pregnancies following myomectomy: A multicenter case series

Uterine rupture in pregnancies following myomectomy: A multicenter case series

Spontaneous Rupture of the Pregnant Uterus following Salpingectomy: A Literature Review

Successful outcome of a triplet pregnancy following laparoscopic myomectomy for infertility: a unique case report

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