Successful outcome of pregnancy and delivery after surgical correction in a patient with complete uterine rupture

Мұқаба

Дәйексөз келтіру

Толық мәтін

Ашық рұқсат Ашық рұқсат
Рұқсат жабық Рұқсат берілді
Рұқсат жабық Рұқсат ақылы немесе тек жазылушылар үшін

Аннотация

Background: Complete uterine rupture is a serious complication that poses significant difficulties in reconstructive surgery. The results are frequently disappointing due to the high probability of postoperative scar defect and cervical canal atresia which eventually lead to hysterectomy.

Case report: The present case report details a rare clinical observation of a favorable outcome of pregnancy and childbirth as a result of surgical treatment, namely uterocervical junction after complete detachment of the uterus from the cervix. Magnetic resonance imaging was used for the diagnosis and preoperative modelling of the anatomy of the internal genitalia. Operative treatment was completely performed through laparoscopic access. There were the following important issues: mobilization and anatomization of the separated (dislocated) segments of the cervix and uterus, excision of scar tissue, suturing through all layers of myometrium, matching of segments and reconstitution of uterine anatomy. The regeneration period of the postoperative scar was 12 months. The patient became pregnant 6 months after she stopped taking contraception and underwent progesterone support and Arabin pessary placement. The patient underwent caesarean section at 35 weeks gestation after a course of prophylaxis for fetal respiratory distress syndrome. No visible defects were found during the exploration of the postoperative scar area.

Conclusion: The presented rare clinical observation of complete uterine rupture due to severe trauma showed the high informative value of imaging diagnosis before planning surgery. Reconstructive surgery, therapy aimed at prolonging pregnancy, and timely delivery contributed to the successful outcome, resulting in the birth of a healthy baby.

Толық мәтін

Рұқсат жабық

Авторлар туралы

Zograb Makiyan

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Хат алмасуға жауапты Автор.
Email: makiyan@mail.ru
ORCID iD: 0000-0002-0463-1913

Dr. Med. Sci., Leading Researcher at the Department of Operative Gynecology

Ресей, Moscow

Nana Tetruashvili

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: tetrauly@mail.ru
ORCID iD: 0000-0002-9201-2281

Dr. Med. Sci., Head of the 2nd Obstetric Department of Pregnancy Pathology

Ресей, Moscow

Leyla Adamyan

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: adamyanleila@gmai.com
ORCID iD: 0000-0002-3253-4512

Dr. Med. Sci., Professor, Academician of the Russian Academy of Sciences, Head of the Gynecological Department

Ресей, Moscow

Aleksandr Gus

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: aleksandr_gus@mail.ru
ORCID iD: 0000-0003-1377-3128

Dr. Med. Sci., Professor, Chief Researcher at the Department of Ultrasound and Functional Diagnostics

Ресей, Moscow

Vladimir Bychenko

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_bychenko@yandex.ru
ORCID iD: 0000-0002-1459-4124

PhD, Head of the Department of Radiation Diagnostics

Ресей, Moscow

Әдебиет тізімі

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Әрекет
1. JATS XML
Жүктеу
2. Fig. 1. MPT. T2-weighted images in the sagittal plane. a. Uterus dimensions: longitudinal without cervix - 6.6 cm, anterior-posterior - 4.1 cm, transverse - 5.1 cm. The area of the inner pharynx is obliterated (red marker). The uterine cavity is expanded due to hemorrhagic contents - a hematometer; b. The cervix is blindly closed (red marker), dislocated to the right, represented on the sagittal scan in a different plane. The length is up to 4.2 cm. The outer pharynx is closed, the inner pharynx is not visible. Diastasis - the distance from the lower pole of the obliterated uterine cavity to the cervix was 36 mm. Diagnosis: Complete separation of the uterus from the cervix. Hematometer

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Метадеректер
3. Fig. 2. Stages of laparoscopic metroplasty, creation of the uterocervical fossa. a. During an examination of the anterior surface of the uterus, a furrow was revealed (indicated by the manipulator) and mobility between the lower segment of the uterine body and the proximal part of the cervix; b. An examination of the posterior surface of the uterus revealed a furrow (indicated by the manipulator) and mobility between the lower segment of the uterine body and the proximal cervix; B. After cutting off the scar tissue in the area of the blindly closed parts of the body and cervix, the lumen of the uterine cavity is opened. The uterine body is placed in the inversion position (rotated 180 degrees), bottom down. The proximal part of the cervix and the distal part of the uterine body were compared, and the first suture was applied to the posterior wall through the lumen of the cervical canal. The lumen of the cervical canal and the uterine cavity are indicated by white arrows; d. The anterior wall of the uterus. After suturing the posterior wall, fragments of the anterior uterine wall were compared and a suture was applied along the anterior left side wall

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4. Fig. 3. Color map of the kinetics of the paramagnetic contrast agent Washln (assessment of the accumulation rate) superimposed on a T2-weighted MR tomogram in the sagittal plane. According to the color mapping data, the blood flow in the area of postoperative changes is not impaired.

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5. 4. According to ultrasound data: pregnancy is 11-12 weeks. The thickness of the postoperative scar in the lower uterine segment is the study g 1 was conducted by Professor Gus A.I.)

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6. 5. Demonstration of the lower segment of the uterus during cesarean section. A scar on the border of the neck | and:and and the body of the uterus consist of

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