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Uterine rupture before the onset of labor following extensive resection of deeply infiltrating endometriosis with myometrial invasion
Author(s) -
Fettback Paula B.,
Pereira Ricardo M.A.,
Domingues Thais S.,
Zacharias Karla G.,
Chamié Luciana P.,
Serafini Paulo C.
Publication year - 2015
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2015.01.007
Subject(s) - medicine , endometriosis , resection , myometrium , uterine rupture , gynecology , obstetrics , uterus , surgery
The risk of uterine rupture (UR) before the onset of labor has been investigated in women who have undergone cesarean deliveries with previous classical incision and in those with thin lower-uterinesegment defects [1,2]. Previous myomectomies are also a known risk factor for UR [1]. Additionally, evidence published in the past three decades suggests that extensive resection of endometriosis developing within the uterine wall could increase the chances of UR [3–6]. Deeply infiltrating endometriosis (DIE) is characterized by the presence of endometrial glands and stroma outside the uterus. Deep infiltration into the myometrium is a form of DIE that begins at the uterine serosa and advances toward the endometrium. The richly vascularized uterine smooth muscle offers a favorable pathway for DIE to develop [7]. Surgical radical resection is the best option to control DIE. Unfortunately, complete resection of DIE within the uterus can cause substantial thinning of the uterine wall, leaving these areas susceptible to UR during pregnancy. Additionally, the modified blood supply in the scar tissue is associated with local ischemia.