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Re: Vaginal Birth after uterine perforation?From: ainsron (ainsron@sbcglobal.net)Thu Aug 9 10:09:48 2007
I feel there is a big difference between a uterine perforation with an IUD and the potential damage caused by a myomectomy. If the uterine perforation was caused by penetrating trauma by a large object, I would be concerned. What is the diameter of an IUD? 3 mm. The introducer sheath is 5mm. What would you tell a patient whom you perforate during a D&C with the uterine sound? I doubt you would tell her that she needed a C/S for future pregnancies, I certainly wouldn't. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain Ramirez Sent: Wednesday, August 08, 2007 8:37 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Vaginal Birth after uterine perforation? IMHO, any injury to the uterine body is a potential source of uterine rupture - here are some more.. Ef Spontaneous uterine rupture at thirty-three weeks subsequent to previous superficial laparoscopic myomectomy. Pelosi MA, Pelosi MA, Pelosi MA 3rd Am J Obstet Gynecol (1997 Dec) 177(6):1547-9 ISSN: 0002-9378 Laparoscopy Leiomyoma Postoperative Complications Uterine Neoplasms Uterine Rupture Surgical Procedures, Laparoscopic Adult Case Report Cesarean Section Emergency Medical Services Female Human Pregnancy Pregnancy Trimester, Third Electrocardiography Medline Database Healthstar Database Cancerlit Database Abstract Obstetric uterine rupture has previously been reported after the laparoscopic removal of deep intramural myomas, but never has it been reported to follow the removal of superficial myomas. A 39-year-old primigravid woman with a history of a superficial subserous laparoscopic myomectomy was seen for acute abdominal Top of Abstract symptoms at 33 weeks of gestation. Emergency cesarean laparotomy confirmed a spontaneous rupture of the uterine fundus with extrusion of the intact fetal sac into the upper abdomen. This is the first reported case of obstetric uterine rupture subsequent to the removal of a superficial myoma by laparoscopic techniques. Uterine rupture after laparoscopic removal of a pedunculated myoma. Parker WH, Iacampo K, Long T J Minim Invasive Gynecol (2007 May-Jun) 14(3):362-4 ISSN: 1553-4650 Laparoscopy Leiomyoma Uterine Neoplasms Uterine Rupture Adult Electrocoagulation Female Humans Pregnancy Wound Healing Abstract A patient conceived 7 years after undergoing a routine laparoscopic myomectomy of an 11-cm pedunculated myoma. Monopolar modulated current (coagulating) was used for hemostasis, and no suturing was necessary. The pregnancy was uneventful until the 34th week, when pain and Top of Abstract contractions signaled uterine rupture. Mother and baby did well after emergency cesarean section. A wide area of adjacent tissue injury after complete hemostasis with monopolar modulated current (coagulating) was felt to be responsible for poor myometrial healing and subsequent rupture. Spontaneous uterine rupture at 35 weeks' gestation, 3 years after laparoscopic myomectomy, without signs of fetal distress. Banas T, Klimek M, Fugiel A, Skotniczny K J Obstet Gynaecol Res (2005 Dec) 31(6):527-30 ISSN: 1341-8076 Laparoscopy Uterine Rupture Adult Cardiotocography Female Fetal Distress Humans Infant, Newborn Leiomyoma Pregnancy Time Factors Uterine Neoplasms CASE REPORTS Abstract Laparoscopic myomectomy (LM) is a recently developed surgical technique, and every obstetrician should be aware of its possible complications, which can occur not only during labor but also during pregnancy. We report a case of a primigravid woman who was hospitalized at 35 weeks' gestation because of irregular abdominal pain. She conceived spontaneously 3 years after LM. After a 20-h stay on the obstetrician ward due to increased abdominal tenderness and vaginal bleeding, the Top of Abstract patient was qualified for an emergency cesarean section without any symptoms of fetal distress in cardiotocography. During cesarean section a newborn with 9 Apgar points was delivered and a rupture of the uterine wall was seen. Dehiscence of the pregnant uterus following LM is an incidental case, and can therefore be misdiagnosed. Close attention should be paid to every pregnancy in previously operated uteri as the dehiscence of the pregnant uterus can occur without symptoms of fetal distress. Uterine rupture after laparoscopic myomectomy. Lieng M, Istre O, Langebrekke A J Am Assoc Gynecol Laparosc (2004 Feb) 11(1):92-3 ISSN: 1074-3804 Laparoscopy Leiomyoma Postoperative Complications Pregnancy Complications Uterine Neoplasms Uterine Rupture Adult Cesarean Section Female Fertilization in Vitro Human Infertility, Female Pregnancy CASE REPORTS Abstract Myomectomy is performed frequently to preserve or increase fertility, although the risk of future uterine rupture is a major concern of any surgery of the uterus. A 36-year-old woman underwent laparoscopic removal of a pendunculated myoma, and 6 weeks later she conceived after IVF. At 35.5 weeks' gestation she was Top of Abstract admitted to the hospital because of abdominal pain. Cesarean section revealed rupture of the uterine wall at the site of the myoma. This and similar case reports indicate that inadequate laparoscopic suturing is not the only factor involved in rupture of the uterine wall during pregnancy after laparoscopic myomectomy Uterine rupture in pregnancy subsequent to previous laparoscopic electromyolysis. Case report and review of the literature. Nkemayim DC, Hammadeh ME, Hippach M, Mink D, Schmidt W Arch Gynecol Obstet (2000 Nov) 264(3):154-6 ISSN: 0932-0067 Electrosurgery Gynecologic Surgical Procedures Laparoscopy Myometrium Postoperative Complications Uterine Rupture Adult Case Report Female Human Leiomyoma Pregnancy Uterine Neoplasms Review Review Of Reported Cases Abstract Reports about uterine rupture in pregnancy subsequent to previous laparoscopic surgery are not frequent. This may be due to the lack of long term follow up of patients who had undergone this surgery rather than the rarity of this complication. A case of uterine Top of Abstract rupture subsequent to laparoscopic myomectomy is reported. An increasing rate of the occurrence of this complication is reviewed in current literature, thus reiterating the need for more stringent selection criteria for patients who benefit from this surgical technique.
At Wed, 8 Aug 2007, DoctorJoe@aol.com wrote:
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-- “ The greatest obstacle to knowledge is not ignorance, it is the illusion of knowledge.” Daniel J. Boorstin - Historian
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