Lukac Stefan, Wenzel Robin, Schochter Fabienne, Friebe-Hoffmann Ulrike, Hüner Beate, Janni Wolfgang
Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany.
Int J Gynaecol Obstet. 2025 Jan;168(1):57-62. doi: 10.1002/ijgo.15837. Epub 2024 Aug 1.
Fertility-preserving surgery (FPS) in advanced ovarian cancer (AOC) is extremely rare and consequently, information about the pregnancies of these patients is anecdotal. Therefore, management of the pregnancy after AOC is challenging, especially if an unexpected situation arises. A 31-year-old nulliparous woman was admitted to our tertiary hospital in the 18th week of twin pregnancy with sudden severe abdominal pain. Her medical history included a low-grade AOC stage IIIc diagnosed 2 years before pregnancy and treated by debulking FPS and systemic therapy with carboplatin/paclitaxel and bevacizumab. Clinical examination described normal vital signs and peritoneal irritation without any vaginal discharge. Sonography revealed free fluid in the pouch of Douglas and intact twin pregnancy. Laboratory work showed elevated leukocytes with neutrophilia. To evaluate appendicitis magnetic resonance imaging of the abdomen was indicated. This revealed a uterine rupture with the now extra-cavitary position of the twins. Simultaneously, the patient's symptoms deteriorated, and emergency surgery was necessary where hemoperitoneum with avital fetuses were present. Despite excessive blood loss the uterus could be repaired and preserved. Previous resection of the uterine serosa during her debulking FPS, administration of bevacizumab affecting smooth muscles, and overstretching the uterus in the twin pregnancy were considered as possible risk factors for the presenting uterine rupture. Pregnancy after AOC is possible but should be monitored closely, especially due to the hidden long-term consequences of its therapy. In the differential diagnosis of sudden abdominal pain during pregnancy uterine rupture should be considered even in patients with an unscared uterus.
晚期卵巢癌（AOC）中的保留生育功能手术（FPS）极为罕见，因此，关于这些患者妊娠情况的信息多为轶事性的。所以，AOC后妊娠的管理具有挑战性，尤其是出现意外情况时。一名31岁未育女性在双胎妊娠第18周因突发严重腹痛入住我们的三级医院。她的病史包括妊娠前2年诊断为低级别AOC IIIc期，接受了减瘤FPS手术以及卡铂/紫杉醇和贝伐单抗的全身治疗。临床检查显示生命体征正常，有腹膜刺激征但无阴道分泌物。超声检查发现Douglas窝有游离液体，双胎妊娠情况正常。实验室检查显示白细胞升高伴中性粒细胞增多。为评估是否为阑尾炎，进行了腹部磁共振成像检查。结果显示子宫破裂，双胎现已位于子宫外。同时，患者症状恶化，因出现腹腔积血和死胎而必须进行急诊手术。尽管失血过多，但子宫得以修复并保留。其减瘤FPS手术期间子宫浆膜的先前切除、使用影响平滑肌的贝伐单抗以及双胎妊娠时子宫过度伸展被认为是此次子宫破裂的可能危险因素。AOC后妊娠是可能的，但应密切监测，尤其是考虑到其治疗存在潜在的长期后果。在妊娠期间突发腹痛的鉴别诊断中，即使是子宫未受损的患者也应考虑子宫破裂的可能。
