Sun Yan, Huang Jing, Kong Hong-Fang
Department of Obstetrics, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
Medicine (Baltimore). 2019 Nov;98(48):e18182. doi: 10.1097/MD.0000000000018182.
Rupture of an unscarred uterus after in vitro fertilization-embryo transfer (IVF-ET) in a primiparous woman is rare. Assisted reproductive technology (ART)-induced rupture of an unscarred uterus is usually attributable to increased dizygotic twinning rates. Salpingectomy can result in cornual scarring and increase the risk of uterine rupture as well as the mortality rate in a subsequent ectopic pregnancy. Here, we present the first reported case of a spontaneous, third-trimester, uterine rupture in a primiparous woman after IVF-ET due to a history of bilateral salpingectomy because of bilateral oviduct and ovarian cysts; the patient did not have an ectopic pregnancy or any cornual or other uterine scarring during this pregnancy after IVF-ET.
A 24-year-old woman with a history of IVF-ET and bilateral salpingectomy was admitted to our hospital with unexplained acute upper abdominal pain during the third trimester.
The fetal heart rate was abnormal. Abdominal ultrasonography was negative. Computed tomography revealed a small amount of abdominal and pericardial effusion. Laboratory tests revealed increased white blood cells. A diagnosis of pregnancy complicated by acute abdomen was considered. Emergent exploratory laparotomy revealed a uterine rupture at the right fundus adjacent to the right cornual area.
The patient was successfully managed with simultaneous exploratory laparotomy and lower-segment cesarean section. The rupture site was repaired.
Two live infants were uneventfully delivered. Follow-up assessments of the mother and the female baby on the 42nd postpartum day yielded normal results. The male infant was diagnosed with left hydronephrosis and required an operation.
We conclude that the ART-associated increase in dizygotic twinning rates may be a neglected risk factor for spontaneous rupture of the unscarred uterus, especially in patients who have undergone salpingectomy. Uterine rupture should be considered in a patient with multiple pregnancy following IVF-ET who presents with acute abdominal pain and abnormal fetal heart rate. Timely exploratory laparotomy is the key to a good prognosis.
初产妇在体外受精 - 胚胎移植（IVF - ET）后未瘢痕化子宫破裂的情况较为罕见。辅助生殖技术（ART）导致的未瘢痕化子宫破裂通常归因于双卵双胎率增加。输卵管切除术可导致子宫角部瘢痕形成，增加子宫破裂风险以及后续异位妊娠时的死亡率。在此，我们报告首例因双侧输卵管和卵巢囊肿行双侧输卵管切除术后，初产妇在IVF - ET后孕晚期发生自发性子宫破裂的病例；该患者在此次IVF - ET后的孕期未发生异位妊娠或任何子宫角部或其他子宫瘢痕形成。
一名有IVF - ET和双侧输卵管切除术病史的24岁女性，在孕晚期因不明原因的急性上腹部疼痛入院。
胎儿心率异常。腹部超声检查结果为阴性。计算机断层扫描显示腹腔和心包有少量积液。实验室检查显示白细胞增多。考虑诊断为妊娠合并急腹症。急诊剖腹探查发现子宫右侧底部靠近右子宫角区域破裂。
患者通过同时进行剖腹探查和下段剖宫产成功治疗。破裂部位得以修复。
两名活婴顺利分娩。产后第42天对母亲和女婴的随访评估结果正常。男婴被诊断为左肾积水，需要手术治疗。
我们得出结论，ART相关的双卵双胎率增加可能是未瘢痕化子宫自发性破裂的一个被忽视的危险因素，尤其是在接受过输卵管切除术的患者中。对于IVF - ET后多胎妊娠且出现急性腹痛和胎儿心率异常的患者，应考虑子宫破裂。及时进行剖腹探查是良好预后的关键。
