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Recurrent rupture uterus after hysteroscopic resection of uterine septum: A case report
Middle East Fertility Society Journal xxx (2017) xxx–xxx
Contents lists available at ScienceDirect
Middle East Fertility Society Journal journal homepage: www.sciencedirect.com
Recurrent rupture uterus after hysteroscopic resection of uterine septum: A case report Ahmed M. Abbas a,⇑, Mohamed Abdallah a, Armia Michael b a b
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt
a r t i c l e
i n f o
Article history: Received 26 January 2017 Revised 3 February 2017 Accepted 4 February 2017 Available online xxxx Keywords: Rupture uterus Hysteroscopy Maternal morbidity Uterine septum Metroplasty
a b s t r a c t Uterine rupture is a catastrophic obstetrical emergency with unpleasant maternal and fetal outcomes. Operative hysteroscopic procedures can add more risk factor for occurrence of this tragedy. Here, we report a case of spontaneous recurrent rupture uterus at 32 weeks of gestation in a 28-year-old woman with previous history of hysteroscopic resection of uterine septum after development of acute abdomen. Repair of anterior uterine wall longitudinal tear was performed through emergency laparotomy. Surgeons should explain to their patients the hazards of probable risk of recurrent UR in the future pregnancy and to document this discussion in the medical records before proceeding to operative hysteroscopic procedures. Ó 2017 Middle East Fertility Society. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction Although uterine anomalies are relatively infrequent, they have been observed in nearly 15% of patients presented with recurrent miscarriage (RM) [1]. Uterine septum is a common finding in women with RM accounting for 3.2–6.9% of women [2]. Hysteroscopy is the gold standard intervention to evaluate the uterine cavity in those patients with the advantage of concurrent treatment through metroplasty [3]. Complications of operative hysteroscopy extensively differs depending on the operative procedure, while surgical complications, including uterine perforation remains low (range 1–2.7%) [4]. Uterine rupture (UR) during pregnancy is a horrible condition that results in high maternal and fetal morbidity and mortality [5]. The incidence of UR is variable according to presence of uterine scar ranging between 0.03 and 0.08% in women with an unscarred uterus and 0.3–1.7% in those with previous uterine scar [6,7]. UR during pregnancy following the operative hysteroscopy seems to be a rare and late complication of hysteroscopic surgery [8]. However, recurrent UR has been reported in the literature in the pregnancies consequent to hysteroscopic metroplasty [9,10]. Pregnancy outcome after conservative management of UR has been addressed only by small case series [11]. Recurrent UR is
Peer review under responsibility of Middle East Fertility Society. ⇑ Corresponding author at: Woman’s Health Hospital, 71511 Assiut, Egypt. E-mail address: [email protected] (A.M. Abbas).
associated with a high maternal and perinatal morbidity. In spite of repair of uterine ruptures is possible, recurrences are frequent, especially after longitudinal upper segment ruptures or short interval between repair and subsequent pregnancy [12]. Here, we present a case of recurrent spontaneous UR in the 36th week of gestation in a woman had previously undergone hysteroscopic resection of uterine septum. 2. Case report In December 2016, a 28-year-old woman, gravida 5 para 1 + 3, has no living children, presented to the emergency department of Assiut Women’s Health Hospital suffering from acute abdomen with loss of fetal movement for 2 h. She was pregnant at 32 weeks gestation based on her last menstrual period. She had a history of recurrent first trimester-miscarriages at 6–9 weeks of gestation. She sought medical advice and hysterosalpingography was done revealed a septate uterus which was confirmed by office hysteroscopy. Hysteroscopic resection of the uterine septum was done 3 years ago, and she became pregnant 4 months after hysetroscopy. In her first pregnancy after metroplasty, she had experienced a UR at her 36th week of gestation, resulted in stillbirth. Her antenatal care was completely normal until hospitalization. Her operative notes reported that laparotomy was performed and repair of large anterior wall uterine tear extending from the fundus downwards by non-absorbable sutures in three layers was done.
http://dx.doi.org/10.1016/j.mefs.2017.02.002 1110-5690/Ó 2017 Middle East Fertility Society. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: A.M. Abbas et al., Recurrent rupture uterus after hysteroscopic resection of uterine septum: A case report, Middle East Fertil Soc J (2017), http://dx.doi.org/10.1016/j.mefs.2017.02.002
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A.M. Abbas et al. / Middle East Fertility Society Journal xxx (2017) xxx–xxx
At admission, the patient was conscious, her blood pressure was 100/60 mmHg, and pulse 112 beats per minute. Generalized abdominal tenderness and rebounding in the lower abdomen were observed on abdominal examination. Minimal vaginal bleeding was noted. Emergency ultrasound was done revealed an empty uterus with single non-viable fetus present outside the uterine cavity and marked intraperitoneal fluid collection. Preoperative hemoglobin level was 8.7 gm/dl and coagulation profile was normal. Based on previous findings, diagnosis of recurrent UR was suspected. Emergency laparotomy through pfannenstiel incision was done under general anesthesia after counseling about her current condition and taking an informed consent. The peritoneal cavity was filled with about 1500 cc blood and a dead fetus was found completely extruded from the uterine cavity through a large longitudinal anterior wall tear (nearly 10 cm) with irregular actively bleeding edges. The uterine tear was repaired in three-layers using non-absorbable sutures (Fig. 1), and then the abdomen was closed in layers after normal saline lavage. The patient received 4 units of packed RBCs during the surgery. Postoperative haemoglobin level was 10.5 gm/dl. The patient was discharged on day 5 after the operation with no complaint. She was counselled about the use of effective contraceptive method for at least 2 years with strict follow up in her subsequent pregnancies.
3. Discussion To the best of our knowledge, this is one of the few publications in the literature to report a recurrent UR during pregnancy after hysteroscopic metroplasty. Patients with septate uterus are associated with higher rates of recurrent miscarriage, preterm labor and
Fig. 1. The uterus showing anterior wall longitudinal tear extending from the fundus downwards after repair.
intrauterine growth restriction [1]. Hysteroscopic metroplasty significantly improves pregnancy outcomes among women with septate uterus [13]. As in the case of our patient, she had spontaneous three first-trimester miscarriages, and no further miscarriages had occurred after the hysteroscopy, in spite of the recurrent third trimester UR that happened twice. The predisposing factors for UR after hysteroscopic metroplasty can be summed as follows; firstly, the use of electrosurgery which increases the risk of thermal myometrial vascular damage and weakening of the tissue that lead to consequent UR [14]. The monopolar electric current diffuses in the myometrium and can lead to an extensive deep tissue necrosis in the area of the resection. Occurrence of unrecognized perforation during entry of the hysteroscope occurs and this can be avoided by concurrent use of ultrasonography or laparoscopy during the procedure. On the other hand, cases of UR after metroplasty have been described whatever the used method for septum resection (bipolar or monopolar energy, laser, cold scissors) [14]. Previous uterine surgery is the most important risk factor for UR, especially in the third trimester [15]. It can occur following cesarean section (CS) or upper uterine segment surgeries as hysterotomy, classical CS and previous repair of rupture uterus, which carry an increased risk of UR during next pregnancy [16]. UR usually happens earlier than the age of rupture in the previous pregnancy. So, a history of UR should increase the obstetrician’s thought about the possibility of earlier UR recurrence. This progression suggests that the scar tissue formation after surgical repair of each rupture is weaker than that of the previous repair. This was evident in our case as the first UR occurred at 36 weeks of gestation and this time occurred earlier at 32 weeks in the same site. There is no agreement on the safe time between hysteroscopic metroplasty and a subsequent pregnancy [17]. In our case, the first rupture occurred 1 year after the procedure, and subsequent rupture occurred at 2-years interval. Ergenoglu et al. [9] reported a case of recurrent UR three times within 5 years, the first one 2 years after metroplasty. Also, Kasapoglu et al. [10] reported a case of recurrent UR three times with 7 years gap between the first and last one. Abdominal exploration is the only key for successful management of UR. It should be managed in a tertiary level hospital. Repair should be in full thickness and with proper suture materials. An effective method of contraception should be used for at least one year after uterine repair [18] in addition to close monitoring in the next pregnancies. Although the risk of recurrent UR in subsequent pregnancies is 4–19%, repair was indicated in our case as she had no living children. Currently, there is no agreement on the standard follow-up protocol that decreases maternal adverse outcomes among those patients. So, women should be well-informed about the symptoms of UR during pregnancy and clinicians must regard this possibility. This case emphasizes three important clinical points. Firstly, UR should be anticipated in any woman with history of hysteroscopic uterine surgery. Regular antenatal visits at a tertiary hospital should be instituted in their follow-up of future pregnancies. Secondly, it is necessary to inform the patients about the potential risk of UR during pregnancy before performing any uterine surgery. If the patient suffered from abdominal pain, UR must be suspected and recurrent UR after hysteroscopic metroplasty must be in mind. Finally, the late complications of operative hysteroscopy caused by myometrial damage during the surgery can cause disastrous consequences during a subsequent pregnancy. These long-term problems should lead the gynecologists to carefully select patients who will get benefits from metroplasty to minimize the possibility of unnecessary myometrial damage.
Please cite this article in press as: A.M. Abbas et al., Recurrent rupture uterus after hysteroscopic resection of uterine septum: A case report, Middle East Fertil Soc J (2017), http://dx.doi.org/10.1016/j.mefs.2017.02.002
A.M. Abbas et al. / Middle East Fertility Society Journal xxx (2017) xxx–xxx
4. Conclusions Although rare, UR as a late complication of a previous hysteroscopic metroplasty is being reported increasingly and obstetricians should be aware of this condition due to its severe life-threatening complications for both mother and fetus until a sensitive predictive method is revealed. Rupture uterus should be suspected after any uterine surgery in pregnant women presented with acute abdomen. References [1] S.Y. Brucker, K. Rall, R. Campo, P. Oppelt, K. Isaacson, Treatment of congenital malformations, Semin. Reprod. Med. 29 (2) (2011) 101–112. [2] M. Sugiura-Ogasawara, Y. Ozaki, K. Katano, N. Suzumori, E. Mizutani, Uterine anomaly and recurrent pregnancy loss, Semin. Reprod. Med. 29 (6) (2011) 514–521. [3] G. Bacsko, Uterine surgery by operative hysteroscopy, Eur. J. Obstet. Gynecol. Reprod. Biol. 71 (2) (1997) 219–222. [4] F.W. Jansen, C.B. Vredevoogd, K.V. Ulzen, J. Hermans, J.B. Trimbos, T.C.M. Trimbos-Kemper, Complications of hysteroscopy: a prospective, multicenter study, Obstet. Gynecol. 96 (2000) 266–270. [5] M.J. Turner, Uterine rupture, Best. Pract. Res. Clin. Obstet. Gynaecol. 16 (2002) 69–79. [6] K.E. Kieser, T.F. Baskett, 10-year population-based study of uterine rupture, Obstet. Gynecol. 100 (2002) 749–753. [7] A.S. Leung, E.K. Leung, R.H. Paul, Uterine rupture after previous cesarean delivery: maternal and fetal consequences, Am. J. Obstet. Gynecol. 169 (1993) 945–950.
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[8] P. Kerimis, M. Zolti, G. Sinwany, S. Mashiach, H. Carp, Uterine rupture after hysteroscopic resection of uterine septum, Fertil. Steril. 77 (2002) 618–620. [9] M. Ergenoglu, A.O. Yeniel, N. Yıldırım, A. Akdemir, S. Yucebilgin, Recurrent uterine rupture after hysterescopic resection of the uterine septum, Int. J. Surg. Case Rep. 4 (2) (2013) 182–184. [10] T. Kasapoglu, D. Kasapoglu, O. Deren, Successful management of the recurrent uterine rupture after the uterine septum resection, Case Rep. Women’s Health 8 (2015) 13–16. [11] N.S. Fox, R.S. Gerber, M. Mourad, D.H. Saltzman, C.K. Klauser, S. Gupta, et al., Pregnancy outcomes in patients with prior uterine rupture or dehiscence, Obstet. Gynecol. 123 (2014) 785–789. [12] S. Shick, R. Neiger, Pregnancy outcome in women with history of uterine rupture or dehiscence, Obstet. Gynecol. Cases Rev. 2 (2015) 5. [13] G. Zlopasa, S. Skrablin, D. Kalafatic´, V. Banovic´, J. Lesin, Uterine anomalies and pregnancy outcome following resectoscope metroplasty, Int. J. Gynaecol. Obstet. 98 (2) (2007) 129–133. [14] L. Sentilhes, F. Sergent, A. Berthier, L. Catala, P. Descamps, L. Marpeau, Uterine rupture following operative hysteroscopy, Gynecol. Obstet. Fertil. 34 (2006) 1064–1070. [15] K.Y. Kong, S.K. Chang, Y.J. Kim, J.Y. Lee, J.K. Chung, A clinical evaluation on the rupture of the gravid uterus, Korean J. Obstet. Gynecol. 36 (1993) 1486–1490. [16] M. Mahoney, J. Moldenhauer, M. Treadwell, Subsequent pregnancy outcome with prior uterine rupture, Am. J. Obstet. Gynecol. 193 (2005) S127. [17] L. Sentilhes, F. Sergent, H. Roman, E. Verspyck, L. Marpeau, Late complications of operative hysteroscopy: predicting patients at risk of uterine rupture during subsequent pregnancy, Eur. J. Obstet. Gynecol. Reprod. Biol. 120 (2005) 134– 138. [18] N. Singh, U. Singh, M.L. Verma, Ruptured bicornuate uterus mimicking ectopic pregnancy: a case report, J. Obstet. Gynaecol. Res. 39 (1) (2013) 364–366.
Please cite this article in press as: A.M. Abbas et al., Recurrent rupture uterus after hysteroscopic resection of uterine septum: A case report, Middle East Fertil Soc J (2017), http://dx.doi.org/10.1016/j.mefs.2017.02.002
Contents lists available at ScienceDirect
Middle East Fertility Society Journal journal homepage: www.sciencedirect.com
Recurrent rupture uterus after hysteroscopic resection of uterine septum: A case report Ahmed M. Abbas a,⇑, Mohamed Abdallah a, Armia Michael b a b
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt
a r t i c l e
i n f o
Article history: Received 26 January 2017 Revised 3 February 2017 Accepted 4 February 2017 Available online xxxx Keywords: Rupture uterus Hysteroscopy Maternal morbidity Uterine septum Metroplasty
a b s t r a c t Uterine rupture is a catastrophic obstetrical emergency with unpleasant maternal and fetal outcomes. Operative hysteroscopic procedures can add more risk factor for occurrence of this tragedy. Here, we report a case of spontaneous recurrent rupture uterus at 32 weeks of gestation in a 28-year-old woman with previous history of hysteroscopic resection of uterine septum after development of acute abdomen. Repair of anterior uterine wall longitudinal tear was performed through emergency laparotomy. Surgeons should explain to their patients the hazards of probable risk of recurrent UR in the future pregnancy and to document this discussion in the medical records before proceeding to operative hysteroscopic procedures. Ó 2017 Middle East Fertility Society. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction Although uterine anomalies are relatively infrequent, they have been observed in nearly 15% of patients presented with recurrent miscarriage (RM) [1]. Uterine septum is a common finding in women with RM accounting for 3.2–6.9% of women [2]. Hysteroscopy is the gold standard intervention to evaluate the uterine cavity in those patients with the advantage of concurrent treatment through metroplasty [3]. Complications of operative hysteroscopy extensively differs depending on the operative procedure, while surgical complications, including uterine perforation remains low (range 1–2.7%) [4]. Uterine rupture (UR) during pregnancy is a horrible condition that results in high maternal and fetal morbidity and mortality [5]. The incidence of UR is variable according to presence of uterine scar ranging between 0.03 and 0.08% in women with an unscarred uterus and 0.3–1.7% in those with previous uterine scar [6,7]. UR during pregnancy following the operative hysteroscopy seems to be a rare and late complication of hysteroscopic surgery [8]. However, recurrent UR has been reported in the literature in the pregnancies consequent to hysteroscopic metroplasty [9,10]. Pregnancy outcome after conservative management of UR has been addressed only by small case series [11]. Recurrent UR is
Peer review under responsibility of Middle East Fertility Society. ⇑ Corresponding author at: Woman’s Health Hospital, 71511 Assiut, Egypt. E-mail address: [email protected] (A.M. Abbas).
associated with a high maternal and perinatal morbidity. In spite of repair of uterine ruptures is possible, recurrences are frequent, especially after longitudinal upper segment ruptures or short interval between repair and subsequent pregnancy [12]. Here, we present a case of recurrent spontaneous UR in the 36th week of gestation in a woman had previously undergone hysteroscopic resection of uterine septum. 2. Case report In December 2016, a 28-year-old woman, gravida 5 para 1 + 3, has no living children, presented to the emergency department of Assiut Women’s Health Hospital suffering from acute abdomen with loss of fetal movement for 2 h. She was pregnant at 32 weeks gestation based on her last menstrual period. She had a history of recurrent first trimester-miscarriages at 6–9 weeks of gestation. She sought medical advice and hysterosalpingography was done revealed a septate uterus which was confirmed by office hysteroscopy. Hysteroscopic resection of the uterine septum was done 3 years ago, and she became pregnant 4 months after hysetroscopy. In her first pregnancy after metroplasty, she had experienced a UR at her 36th week of gestation, resulted in stillbirth. Her antenatal care was completely normal until hospitalization. Her operative notes reported that laparotomy was performed and repair of large anterior wall uterine tear extending from the fundus downwards by non-absorbable sutures in three layers was done.
http://dx.doi.org/10.1016/j.mefs.2017.02.002 1110-5690/Ó 2017 Middle East Fertility Society. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: A.M. Abbas et al., Recurrent rupture uterus after hysteroscopic resection of uterine septum: A case report, Middle East Fertil Soc J (2017), http://dx.doi.org/10.1016/j.mefs.2017.02.002
2
A.M. Abbas et al. / Middle East Fertility Society Journal xxx (2017) xxx–xxx
At admission, the patient was conscious, her blood pressure was 100/60 mmHg, and pulse 112 beats per minute. Generalized abdominal tenderness and rebounding in the lower abdomen were observed on abdominal examination. Minimal vaginal bleeding was noted. Emergency ultrasound was done revealed an empty uterus with single non-viable fetus present outside the uterine cavity and marked intraperitoneal fluid collection. Preoperative hemoglobin level was 8.7 gm/dl and coagulation profile was normal. Based on previous findings, diagnosis of recurrent UR was suspected. Emergency laparotomy through pfannenstiel incision was done under general anesthesia after counseling about her current condition and taking an informed consent. The peritoneal cavity was filled with about 1500 cc blood and a dead fetus was found completely extruded from the uterine cavity through a large longitudinal anterior wall tear (nearly 10 cm) with irregular actively bleeding edges. The uterine tear was repaired in three-layers using non-absorbable sutures (Fig. 1), and then the abdomen was closed in layers after normal saline lavage. The patient received 4 units of packed RBCs during the surgery. Postoperative haemoglobin level was 10.5 gm/dl. The patient was discharged on day 5 after the operation with no complaint. She was counselled about the use of effective contraceptive method for at least 2 years with strict follow up in her subsequent pregnancies.
3. Discussion To the best of our knowledge, this is one of the few publications in the literature to report a recurrent UR during pregnancy after hysteroscopic metroplasty. Patients with septate uterus are associated with higher rates of recurrent miscarriage, preterm labor and
Fig. 1. The uterus showing anterior wall longitudinal tear extending from the fundus downwards after repair.
intrauterine growth restriction [1]. Hysteroscopic metroplasty significantly improves pregnancy outcomes among women with septate uterus [13]. As in the case of our patient, she had spontaneous three first-trimester miscarriages, and no further miscarriages had occurred after the hysteroscopy, in spite of the recurrent third trimester UR that happened twice. The predisposing factors for UR after hysteroscopic metroplasty can be summed as follows; firstly, the use of electrosurgery which increases the risk of thermal myometrial vascular damage and weakening of the tissue that lead to consequent UR [14]. The monopolar electric current diffuses in the myometrium and can lead to an extensive deep tissue necrosis in the area of the resection. Occurrence of unrecognized perforation during entry of the hysteroscope occurs and this can be avoided by concurrent use of ultrasonography or laparoscopy during the procedure. On the other hand, cases of UR after metroplasty have been described whatever the used method for septum resection (bipolar or monopolar energy, laser, cold scissors) [14]. Previous uterine surgery is the most important risk factor for UR, especially in the third trimester [15]. It can occur following cesarean section (CS) or upper uterine segment surgeries as hysterotomy, classical CS and previous repair of rupture uterus, which carry an increased risk of UR during next pregnancy [16]. UR usually happens earlier than the age of rupture in the previous pregnancy. So, a history of UR should increase the obstetrician’s thought about the possibility of earlier UR recurrence. This progression suggests that the scar tissue formation after surgical repair of each rupture is weaker than that of the previous repair. This was evident in our case as the first UR occurred at 36 weeks of gestation and this time occurred earlier at 32 weeks in the same site. There is no agreement on the safe time between hysteroscopic metroplasty and a subsequent pregnancy [17]. In our case, the first rupture occurred 1 year after the procedure, and subsequent rupture occurred at 2-years interval. Ergenoglu et al. [9] reported a case of recurrent UR three times within 5 years, the first one 2 years after metroplasty. Also, Kasapoglu et al. [10] reported a case of recurrent UR three times with 7 years gap between the first and last one. Abdominal exploration is the only key for successful management of UR. It should be managed in a tertiary level hospital. Repair should be in full thickness and with proper suture materials. An effective method of contraception should be used for at least one year after uterine repair [18] in addition to close monitoring in the next pregnancies. Although the risk of recurrent UR in subsequent pregnancies is 4–19%, repair was indicated in our case as she had no living children. Currently, there is no agreement on the standard follow-up protocol that decreases maternal adverse outcomes among those patients. So, women should be well-informed about the symptoms of UR during pregnancy and clinicians must regard this possibility. This case emphasizes three important clinical points. Firstly, UR should be anticipated in any woman with history of hysteroscopic uterine surgery. Regular antenatal visits at a tertiary hospital should be instituted in their follow-up of future pregnancies. Secondly, it is necessary to inform the patients about the potential risk of UR during pregnancy before performing any uterine surgery. If the patient suffered from abdominal pain, UR must be suspected and recurrent UR after hysteroscopic metroplasty must be in mind. Finally, the late complications of operative hysteroscopy caused by myometrial damage during the surgery can cause disastrous consequences during a subsequent pregnancy. These long-term problems should lead the gynecologists to carefully select patients who will get benefits from metroplasty to minimize the possibility of unnecessary myometrial damage.
Please cite this article in press as: A.M. Abbas et al., Recurrent rupture uterus after hysteroscopic resection of uterine septum: A case report, Middle East Fertil Soc J (2017), http://dx.doi.org/10.1016/j.mefs.2017.02.002
A.M. Abbas et al. / Middle East Fertility Society Journal xxx (2017) xxx–xxx
4. Conclusions Although rare, UR as a late complication of a previous hysteroscopic metroplasty is being reported increasingly and obstetricians should be aware of this condition due to its severe life-threatening complications for both mother and fetus until a sensitive predictive method is revealed. Rupture uterus should be suspected after any uterine surgery in pregnant women presented with acute abdomen. References [1] S.Y. Brucker, K. Rall, R. Campo, P. Oppelt, K. Isaacson, Treatment of congenital malformations, Semin. Reprod. Med. 29 (2) (2011) 101–112. [2] M. Sugiura-Ogasawara, Y. Ozaki, K. Katano, N. Suzumori, E. Mizutani, Uterine anomaly and recurrent pregnancy loss, Semin. Reprod. Med. 29 (6) (2011) 514–521. [3] G. Bacsko, Uterine surgery by operative hysteroscopy, Eur. J. Obstet. Gynecol. Reprod. Biol. 71 (2) (1997) 219–222. [4] F.W. Jansen, C.B. Vredevoogd, K.V. Ulzen, J. Hermans, J.B. Trimbos, T.C.M. Trimbos-Kemper, Complications of hysteroscopy: a prospective, multicenter study, Obstet. Gynecol. 96 (2000) 266–270. [5] M.J. Turner, Uterine rupture, Best. Pract. Res. Clin. Obstet. Gynaecol. 16 (2002) 69–79. [6] K.E. Kieser, T.F. Baskett, 10-year population-based study of uterine rupture, Obstet. Gynecol. 100 (2002) 749–753. [7] A.S. Leung, E.K. Leung, R.H. Paul, Uterine rupture after previous cesarean delivery: maternal and fetal consequences, Am. J. Obstet. Gynecol. 169 (1993) 945–950.
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[8] P. Kerimis, M. Zolti, G. Sinwany, S. Mashiach, H. Carp, Uterine rupture after hysteroscopic resection of uterine septum, Fertil. Steril. 77 (2002) 618–620. [9] M. Ergenoglu, A.O. Yeniel, N. Yıldırım, A. Akdemir, S. Yucebilgin, Recurrent uterine rupture after hysterescopic resection of the uterine septum, Int. J. Surg. Case Rep. 4 (2) (2013) 182–184. [10] T. Kasapoglu, D. Kasapoglu, O. Deren, Successful management of the recurrent uterine rupture after the uterine septum resection, Case Rep. Women’s Health 8 (2015) 13–16. [11] N.S. Fox, R.S. Gerber, M. Mourad, D.H. Saltzman, C.K. Klauser, S. Gupta, et al., Pregnancy outcomes in patients with prior uterine rupture or dehiscence, Obstet. Gynecol. 123 (2014) 785–789. [12] S. Shick, R. Neiger, Pregnancy outcome in women with history of uterine rupture or dehiscence, Obstet. Gynecol. Cases Rev. 2 (2015) 5. [13] G. Zlopasa, S. Skrablin, D. Kalafatic´, V. Banovic´, J. Lesin, Uterine anomalies and pregnancy outcome following resectoscope metroplasty, Int. J. Gynaecol. Obstet. 98 (2) (2007) 129–133. [14] L. Sentilhes, F. Sergent, A. Berthier, L. Catala, P. Descamps, L. Marpeau, Uterine rupture following operative hysteroscopy, Gynecol. Obstet. Fertil. 34 (2006) 1064–1070. [15] K.Y. Kong, S.K. Chang, Y.J. Kim, J.Y. Lee, J.K. Chung, A clinical evaluation on the rupture of the gravid uterus, Korean J. Obstet. Gynecol. 36 (1993) 1486–1490. [16] M. Mahoney, J. Moldenhauer, M. Treadwell, Subsequent pregnancy outcome with prior uterine rupture, Am. J. Obstet. Gynecol. 193 (2005) S127. [17] L. Sentilhes, F. Sergent, H. Roman, E. Verspyck, L. Marpeau, Late complications of operative hysteroscopy: predicting patients at risk of uterine rupture during subsequent pregnancy, Eur. J. Obstet. Gynecol. Reprod. Biol. 120 (2005) 134– 138. [18] N. Singh, U. Singh, M.L. Verma, Ruptured bicornuate uterus mimicking ectopic pregnancy: a case report, J. Obstet. Gynaecol. Res. 39 (1) (2013) 364–366.
Please cite this article in press as: A.M. Abbas et al., Recurrent rupture uterus after hysteroscopic resection of uterine septum: A case report, Middle East Fertil Soc J (2017), http://dx.doi.org/10.1016/j.mefs.2017.02.002