妊娠34週で陣痛発来前に子宮破裂を来たした腹腔鏡下子宮筋腫核出術後妊娠の1例

抄録

Introduction: Recently, the use of laparoscopic myomectomy (LM) is increasing. We found several case reports of uterine rupture in pregnancy after LM. Herein, we report a case of uterine rupture at 34 weeks of gestation prior to labor onset in a patient with a history of LM.

Case: A 43-year-old nulliparous woman conceived by cryopreserved embryo transfer after LM, thereby seven myomas were removed, including a 5-cm submucosal myoma in the posterior uterine wall. Antenatal follow-up at another clinic was uneventful until she presented with intense and abrupt abdominal pain and vomiting at 34 weeks of pregnancy. She was transferred to our hospital because of acute abdomen. Despite the presence of pain radiating from the uterus toward the epigastric region, ultrasonography revealed the intact anterior wall of her uterus. Within 2 hours, fetal bradycardia and fluid collection in the pouch of Morison were observed. Uterine rupture was suspected based on the myomectomy records attached to the referral letter, and emergency caesarian section was performed. The infant weighed 2032 g at birth, with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively, and umbilical artery pH of 7.34. The infant was admitted to the neonatal intensive care unit because of the low birth weight. The ruptured left posterior uterine wall, matching the enucleated site, was repaired.

Discussion: The posterior location of the rupture made immediate diagnosis difficult. However, with the operative records, rupture was promptly suspected, urging for laparotomy. LM is a common procedure performed in women seeking for infertility treatment. Operatives notes on myomectomy are important in the consultation for early diagnosis of uterine rupture in pregnancy and shall not be spared for referral.