Unscarred and Scarred Uterine Rupture in Pregnancy: A Six-case Series in Taipei Tzu-Chi Hospital

Objectives: This study included six uterine rupture in pregnancy cases over 12 years at Taipei Buddhist Tzu-Chi Hospital. We describe the clinical features and outcomes of rupture of unscarred uteri and scarred uteri following laparoscopic myomectomy. Materials and methods: This case series was conducted by reviewing medical charts at Taipei Tzu-Chi Hospital from May 2005 to October 2017. Of 22,962 women who gave birth, six women with full-thickness disruption of all uterine layers during pregnancy or delivery were enrolled. Results: Three cases had ruptures of unscarred uteri and three cases had in uteri scarring by previous laparoscopic myomectomy. The overall incidence of uterine rupture was 0.026%. In women with scarred uteri, the risk of uterine rupture was 0.21%. All uterine ruptures occurred after gestation for 34 weeks although ruptures occurred slightly earlier in the scarred group. All cases received hysterorrhaphy. One neonatal death occurred in the unscarred group and one intrauterine fetal death was diagnosed at admission in the scarred group. Conclusion: Although uterine rupture is a rare complication, the risk is higher for uteri scarred by cesarean section, abdominal myomectomy, or laparoscopic myomectomy. Comparison of risk after abdominal and laparoscopic surgery remains a topic of debate. Regardless of the transmyometrial surgical approach, surgeons should limit electrosurgery and perform multilayer closure. Additionally, early detection and management not only improves maternal and fetal outcomes, but also preserves patient fertility. &nbsp