Uterine rupture in pregnancies following myomectomy: A multicenter case series

Abstract

Objective: The 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.

Methods: This 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.

Results: Fourteen 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.

Conclusion: In 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.

Keywords: Myomectomy; Pregnancy outcome; Uterine rupture.

Fig. 1. Cases unsuspected of uterine rupture after myomectomy. Uterine rupture of the ‘hole’ type can be seen at the posterior uterine wall after placental delivery (case 8; A, B), and the myometrium defect (black arrow) is enclosed with the serosal membrane at the fundus of uterus (case 12; C, D). After peritoneal incision, the serosal and myometrial defects of uterus were noted incidentally and the intact fetal membranes remained and protruded forward (case 13; E, F).

Fig. 2. Serious uterine rupture cases after myomectomy with adverse pregnancy outcomes. (A) An approximately 6-cm-sized longitudinal tear can be seen at the right posterior uterine wall, with massive bleeding (case 6). (B) Longitudinal uterine rupture can be noted at right posterior lateral wall (case 9). (C) The uterus is torn longitudinally and ruptured throughout the right posterior wall of the uterus (case 3). (D) Before emergency cesarean section, the fetus was stillborn. Uterine rupture with protrusion of amniotic cavity and placenta, massive hemoperitoneum, and the uterine wall defect (white arrow) are found on abdominal computerized tomography (case 1).