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Case Reports
. 2018 Feb 22:2018:bcr2017222075.
doi: 10.1136/bcr-2017-222075.

A womb like a broken heart

Amenda Ann Davis  1
Affiliations
Case Reports

A womb like a broken heart

Amenda Ann Davis. BMJ Case Rep. .

Abstract

Uterine perforation during hysteroscopic operative procedures is a potential complication well known to gynaecologists. Uterine septa are a commonly encountered Müllerian anomaly related to pregnancy loss and infertility. Hysteroscopic resection of septa has shown to improve pregnancy outcome. There are limited case reports of uterine rupture in subsequent pregnancies after hysteroscopic septal resection. Our patient had a hysteroscopic septal resection done a year prior which was complicated by a uterine fundal perforation, left to spontaneously heal after immediate sealing with cautery. The patient conceived spontaneously soon after and underwent an emergency caesarean section for severe pre-eclampsia. Intraoperatively, after removal of the placenta, we discovered a 3 cm symmetrical circular defect at the fundus of the uterus with no myometrium or serosa. The potentially disastrous consequences of this silent uterine rupture were mitigated due to another life-threatening condition which prevented the onset of labour.

Keywords: obstetrics and gynaecology; pregnancy; reproductive medicine; surgery.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Hysteroscopic view of complete uterine septum.
Figure 2
Figure 2
Symmetrical circular uterine fundal defect created by expansion of perforation during septal resection. There is no myometrium or serosa in this area.
Figure 3
Figure 3
The appearance of a uterine anomaly during pregnancy.
Figure 4
Figure 4
Uterine defect repaired by anterior–posterior apposition and suturing with 1–0 vicryl.
See this image and copyright information in PMC

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