Abstract
Case 1: A 29-year-old nulliparous woman underwent laparoscopic surgery to explore possible cause of infertility. Mild endometriosis was found and endometriotic lesions located on bilateral sacrouterine ligament and posterior uterine surface were extensively electrocauterized. Afterwards, the patient conceived with ICSI-ET at the age of 31 years. At 36+2 weeks' gestation, the patient complained of sudden lower abdominal pain. Fetal cardiotocogram showed persistent fetal bradycardia and she was transported to our hospital. Emergency laparotomy was performed immediately upon arrival. Prolapse of fetal lower extremity from the uterine cavity along with massive hemoperitoneum was observed and a stillborn female baby weighing 2690 g was extracted. Removal of accumulated blood revealed a complete longitudinal uterine rupture along the posterior uterine wall.
Case 2: A 35-year-old nulliparous woman with the history of one laparotomy and two laparoscopic surgeries underwent laparoscopic adenomyomectomy. Three months later, the patient was conceived with IVF-ET. At 28+5 weeks' gestation, the patient complained of sudden lower abdominal pain. Fetal cardiotocogram showed severe late fetal deceleration and she was transported to our hospital. On admission, massive hemoperitoneum was suspected upon examination with ultrasonography, leading to emergency laparotomy. A female baby weighing 1484 g was delivered by lower-segment cesarean section. Removal of accumulated blood revealed a complete longitudinal uterine rupture in the lower part of posterior uterine wall. The newborn suffered from severe intraventricular hemorrhage, resulting in diffuse cerebral atrophy.
In laparoscopic surgery, "limited use of electrocautery against the uterus" and "multilayered closure of the myometrium" should be kept in mind.
