Spontaneous uterine rupture in the early third trimester after laparoscopically assisted myomectomy. A case report.

BACKGROUND: The development of new and innovative laparoscopic instruments has allowed a greater number of gynecologic surgeons to laparoscopically remove large, intramural leiomyomata. Cases of both successful pregnancy and uterine rupture following laparoscopic myomectomy have been reported. This is the first report of uterine rupture in pregnancy following a laparoscopically assisted myomectomy.

CASE: A 26-year-old, nulligravid woman underwent a laparoscopically assisted myomectomy. While the myomectomy had been performed laparoscopically, the uterine incision had been repaired in layers through a minilaparotomy incision. Two years later she became pregnant and, at 29 weeks' gestation, presented to labor and delivery with contractions and uterine tenderness. Over the next several hours, a nonreassuring fetal heart rate developed, and a cesarean section was performed, revealing hemoperitoneum and uterine rupture at the site of the prior myomectomy.

CONCLUSION: The ultimate integrity of a uterine incision may depend not only on how the incision is repaired but also on how it is made. Laparoscopically created uterine incisions may not be as strong as those made at laparotomy, regardless of the method of closure.