Uterine rupture in pregnancy after hysteroscopic septum resection: a 20-year retrospective analysis

Janša, Vid; Laganà, Antonio Simone; Ferrari, Federico; Ghezzi, Fabio; Papler, Tanja Burnik; Bokal, Eda Vrtačnik; Frangež, Helena Ban

doi:10.1080/13645706.2020.1837884

Cited by 22 publications

(21 citation statements)

References 43 publications

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“…Noteworthy, myometrial damage is believed to be the most relevant predisposing factor for uterine rupture, particularly in case of electrosurgery. However, the incidence of uterine rupture during pregnancy is very low ( 45 ). This would support the operation safety of subsequent pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy and Adverse Obstetric Outcomes After Hysteroscopic Resection: A Systematic Review and Meta-Analysis

Zhang

Sun

et al. 2022

Front. Surg.

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ObjectiveAlthough the randomized controlled trial (RCT) of the efficacy of hysteroscopic resection in women with uterine septum has not shown any significant correlation in recent research, motivation for deeper study remains insufficient. In this study, the objective was to determine pregnancy-related outcomes, along with adverse obstetric outcomes, following hysteroscopic resection and also to determine whether women with hysteroscopic resection bear the same outcomes as women with normal uterine cavities.Search MethodsFrom January 1995 to February 2022, a systematic literature review was conducted to identify all studies published concerning the gestation outcomes of women with and without hysteroscopic resection while comparing the gestation outcomes of women after hysteroscopic resection and with a normal uterine cavity. Our primary outcome was the live birth rate (LBR). The secondary outcomes were term delivery, preterm delivery, spontaneous miscarriage, malpresentation, cesarean section, and other adverse obstetric outcomes.Results22 studies were included in this meta-analysis. The control groups of 14 studies were treated women, and the control groups of the other 8 studies were patients bearing a normal uterine cavity. Hysteroscopic resection was related to a higher rate of term delivery (OR = 2.26, 95% CI, 1.26–4.05), and a lower rate of spontaneous abortion (OR = 0.50, 95% CI, 0.27–0.93), and a lower rate of malpresentation (OR = 0.31, 95% CI, 0.19–0.50). Nevertheless, in comparison with the normal uterus group, the rates of preterm birth, cesarean section, and postpartum hemorrhage after resection did not return to normal levels.ConclusionHysteroscopic resection can effectively reduce the risk of abortion and malpresentation in patients possessing a uterine septum while increasing the term delivery rate. Although well-designed RCTs should confirm our meta-analysis, it still bears recommending to patients

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Section: Discussionmentioning

confidence: 99%

Pregnancy and Adverse Obstetric Outcomes After Hysteroscopic Resection: A Systematic Review and Meta-Analysis

Zhang

Sun

et al. 2022

Front. Surg.

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“…As in our case, typically spontaneous uterine scar rupture occurred at 33 weeks of gestation with more than a year's duration of contraception after laparoscopic cornuostomy. A study conducted by Jansa et al [8] reported 4 patients who experienced uterine rupture after hysteroscopic septum resection; the median time to pregnancy among them was 17 months (range 1–60) with acceptable foetal-maternal outcomes. Cornual wedge resection and cornuostomy are the 2 main surgical management procedures for cornual pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous complete uterine rupture with protrusion of foetal limbs at the third trimester following laparoscopic cornuostomy

et al. 2022

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Rationale:Spontaneous complete uterine rupture during gestation is rare and has no specific symptoms; however, it is a life-threatening event for both the fetus and mother. The rupture typically happens in labor and is uncommon before labor. Herein, we present the case of a woman, encountering complete rupture at third trimester followed by laparoscopic cornuostomy.Patient concerns:A 26-year-old woman presented with acute right lower abdominal pain at 33 weeks and 5 days of gestation.Diagnoses:We made a diagnosis of threatened uterine rupture.Intervention:Urgent cesarean section performed. Exploration of the uterine dehiscence wound demonstrated that the myometrium was completely ruptured at the primary laparoscopic surgical scar with a defect of 40 mm, and live birth and preservation of the uterus was achieved.Outcome:On the third day of operation, she had a good recovery and was discharged. After a 6-week postpartum follow-up, she displayed a good level of rehabilitation.Lessons:Pregnancy after laparoscopic cornuostomy should be treated as high-risk gestation and the rupture during gestation of the uterine scar should be suspected once lower abdominal pain occurred. Swift diagnosis and prompt intervention play a crucial role in saving the lives of the fetus and the mother.

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“…Additionally, Vid Jansa's study showed that only 4 cases were found to have uterine rupture during cesarean section delivery [17].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Reproductive Outcomes of Patients With Incomplete and Complete Uterine Septum

Jian

Wang

et al. 2022

Preprint

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Purpose To evaluate the effects of transcervical resection of the septum (TCRS) for two kinds of uterine septum on reproductive outcomes among women of reproductive age.Methods In this retrospective cohort study, we evaluated the reproductive outcomes after TCRS of 57 women with incomplete uterine septum and 23 women with complete uterine septum from January 2010 to December 2018 at the Second Affiliated Hospital of Anhui Medical University.Results In group A, the spontaneous abortion and embryo arrest rates were significantly reduced by TCRS (P<0.001), and the rate of term delivery was improved (P<0.001) after TCRS. In group B, the pregnancy rate was significantly increased (43.5% vs. 82.6%), the rate of spontaneous abortion was significantly reduced (P<0.05), and the rate of term delivery was significantly improved (P<0.001) after operation. The cesarean section rate was significantly higher in group B than in group A after operation (76.5% vs. 47.7%). The pregnancy rate was highest at approximately the 6th month in group A and at approximately the 12th month in group B after operation.Conclusion We found that in patients who underwent TCRS, the rate of spontaneous abortion decreased, and the rates of pregnancy and full-term birth increased; however, the rates of cesarean section and placenta previa increased. Considering the high miscarriage and infertility rates before operation, TCRS seems effective. An incomplete uterine septum resection can lead to an earlier pregnancy than a complete uterine septum resection after surgery, thus ensuring the best time for pregnancy is not missed.

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Uterine rupture in pregnancy after hysteroscopic septum resection: a 20-year retrospective analysis

Cited by 22 publications

References 43 publications

Pregnancy and Adverse Obstetric Outcomes After Hysteroscopic Resection: A Systematic Review and Meta-Analysis

Pregnancy and Adverse Obstetric Outcomes After Hysteroscopic Resection: A Systematic Review and Meta-Analysis

Spontaneous complete uterine rupture with protrusion of foetal limbs at the third trimester following laparoscopic cornuostomy

Comparison of the Reproductive Outcomes of Patients With Incomplete and Complete Uterine Septum

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