Uterine Rupture After Myomectomy:Report Of 3 Cases And Review Of The Literature

Objective:Leiomyomas are a common benign disease of the uterus which may cause an impaired impact on fertility of reproductive-age women,while myomectomy may be the best therapeutic option.However,there is a concern for risk of uterine rupture in the subsequent pregnancy.Uterine rupture is an obstetric emergency with higher risk of morbidity and mortality for both the mother and especially the fetus.With the increasing of reports about uterine rupture after myomectomy,however,there is yet no consensus about the risk factors.The aim of this article is to detail our experiences with three cases of uterine rupture after momectomy and provide a comprehensive review of the risk factors for uterine rupture after myomectomy.Methods:We analyzed retrospectively the clinical data of 3 cases treated in our hospital since records in Lianzhong system.With review of literature,we have a summary of the relationship between uterine rupture and surgical procedures,thermal damage,sutures,factors of myomas,myomectomy-to-conception interval and the way of delivery.Results:All of the cases we reported are of reproductive age.One of them suffered complete uterine rapture at 34-week pregnancy with a history of laparoscopic myomectomy(LM)performed for a single 5cm intramural fibroid located in the cornual region nine months before pregnancy.During LM,surgeons performed an excessive use of electrocautery and did the double-layer closure.The patient was symptomatic for abdominal pain and then she was given a Caesarean section(CS).During the operation,the cornual rupture was repaired with three layers of sutures.Both the mother and fetus got better after operation.Besides,another patient suffered incomplete uterine rupture at 3 8-week pregnancy with a history of laparotomic myomectomy performed for a single 9cm intramural fibroid five months before pregnancy.The patient was asymptomatic before CS and the rupture was repaired during the operation.Both the mother and fetus also got better after operation.Additionally,the third patient suffered incomplete uterine rupture at 36-week pregnancy with a history of laparotomic myomectomy performed for multiple fibroids ranging from 0.5-8cm twenty-one months before pregnancy.The patient was also asymptomatic before CS and the rupture was repaired during the operation.Both the mother and fetus got better after operation.Conclusion:Though it indicates low incidence of uterine rupture,it can be lethal to both pregnant woman and her baby when it occurs,Thus,all caution should be taken to minimize the risk in the process of operation,including limited use of electrosurgery,not breaching the endometrial cavity and multilayered closure of myometrium.Besides,appropriate myomectomy-to-conception interval and the way an of delivery also play important roles.