Uterine rupture at 33rd week of gestation after laparoscopic myomectomy with signs of fetal distress. A case report and review of literature.

OBJECTIVE: We describe a case of uterine rupture (UR) during pregnancy after laparoscopic myomectomy (LM) and discuss the risk factors of UR.

CASE REPORT: A 37-year-old woman with multiple myomas underwent laparoscopic myomectomy. Subserosal and intramural myomas were enucleated, and the myometrial wounds were repaired with single-layer suturing. Sixteen months after the operation, the patient conceived. At 33 weeks of gestation, emergency cesarean section was performed for the indication of fetal distress. A male neonate was delivered without asphyxia. During cesarean section, surgeons identified a 2 × 3 cm myometrial defect at one of the myomectomy sites, and diagnosed incomplete UR. The myometrial defect was repaired with debridement and suturing.

CONCLUSION: Based on the literature review, the risk of UR during pregnancy after LM is estimated to be less than 1% when all the surgical procedures have been performed appropriately. Myomectomy should be performed with careful consideration by surgeons who have good knowledge of the wound healing process in the myometrium.