Conception by IVF-ET after four previous laparotomies, but requiring extraperitoneal cesarean section at 33 weeks due to hypertension and deteriorated renal function

Abstract

A 35-year-old patient (gravida 0, para 0) with a history of four previous laparotomies, including two previous episodes of postoperative intestinal obstruction, conceived by means of in vitro fertilization and embryo transfer (IVF-ET), but was temporarily admitted for hypertension at 19 weeks of pregnancy. One week after discharge, she was readmitted due to re-elevation of blood pressure. Although renal function improved temporarily after the placement of ureteric stents and nephrostomy to treat bilateral hydronephrosis and ureteric dilation, she developed intestinal obstruction at 32 weeks. An extraperitoneal cesarean section was performed at 33 weeks. The patient had intraperitoneal adhesions due to previous multiple laparotomies, and postrenal dysfunction due to the enlarged pregnant uterus, which was the likely cause of hypertension. In patients with similar conditions, it is important to sufficiently explain the risks of serious complications before commencing infertility treatment.