Journal of Obstetrics and Gynaecology, February 2015; 35: 199–202 © 2014 Informa UK, Ltd. ISSN 0144-3615 print/ISSN 1364-6893 online
OBSTETRICS CASE REPORTS
Spontaneous rupture of the uterus during the 1st trimester of pregnancy M. Bandarian1 & F. Bandarian2 1Hazrat Zahra Hospital, Qom University of Medical Sciences, Qom and 2Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
J Obstet Gynaecol Downloaded from informahealthcare.com by University of Bristol on 03/03/15 For personal use only.
DOI: 10.3109/01443615.2014.937334 Correspondence: M. Bandarian, Hazrat Zahra Hospital, Qom University of Medical Sciences, Qom, Iran. E-mail: [email protected]
Introduction The rupture of a gravid uterus describes a full-thickness uterine wall defect, which is a serious pregnancy complication that may be lifethreatening for a mother and her fetus (Dow et al. 2009). Uterine rupture is usually seen in the 3rd trimester of pregnancy and most usually in labour. The incidence of uterine rupture has been reported as between 0.006% and 0.01% in an unscarred uterus and between 0.3% and 1% in those with a previous caesarean section (CS) (Singh and Jain 2000; Landon et al. 2004). There are many conditions associated with increased risk of uterine rupture. Some of these risk factors include: uterine anomalies; fetal anomalies; advanced maternal and gestational age; birth weight ⬎ 4,000 g; use of oxytocin; placenta percreta; multiparity with an inter-delivery interval of ⬍ 18–24 months; tumours (such as malignant mixed mesodermal tumour, müllerian adenofibroma, neuroectodermal tumour and fibroid tumour); previous caesarean section or other uterine surgeries and uterine curettage, of which, previous uterine surgery is the most common risk factor (Ofir et al. 2003; Nkwabong et al. 2007; Landon 2010). Here, we present a case of spontaneous uterine rupture in the 1st trimester, with complete expulsion of the gestational sac, fetus and placenta into the abdominal cavity.
Case report
A 30-year old G4P2 ⫹ 1 pregnant woman was referred as an emergency with sudden onset of severe abdominal pain of 2 h duration. The pain was persistent and accompanied by nausea and vomiting. There was no vaginal bleeding. Based on the 1st trimester sonography, performed at 9 weeks and 1 day, gestational age was estimated to be 11 weeks and 3 days and a singleton pregnancy. She had a history of two caesarean sections (both of them were lower segment CS) and her most recent pregnancy ended in spontaneous miscarriage, which was managed by dilatation and curettage (D&C) 6 months earlier. There was no report of uterine perforation at the D&C. In the physical examination, abdominal distention and tenderness of the lower abdomen were identified. The patient was pale and her pulse rate and blood pressure were 120/min and 85/60 mmHg, respectively. The patient developed orthostatic hypotension in the emergency ward. Intravenous access and urinary catheter were given; the urine output was 100 ml. After this, the patient was initially resuscitated with 2,000 ml Ringer’s solution. The results of her primary laboratory tests were as follows: Hb: 130 g/l; Plt count: 55,000; PT: 13; PTT: 26; INR: 1.1 and fibrinogen: 2.02 g/l.
Emergency abdominal sonography was performed. The image of a live fetus with CRL of 32 mm in the uterine cavity and a subchorionic haematoma of 39 ⫻ 18 mm adjacent to it was seen in the uterus. The placenta was not anterior. There was a large amount of free fluid in the pelvis and abdomen. Based on these clinical, laboratory and sonographic findings, an emergency laparotomy was performed. At laparotomy, approximately 1,500 ml blood, a 1,000 ml clot and an intact gestational sac with a dead fetus that had already been extruded from the uterus into the peritoneal cavity were observed in the abdominal cavity. The uterine rupture occurred exactly on the previous CS incision site. Two units of packed red cells were infused during surgery. The uterine incision was repaired and closed. The patient had no postoperative complications and was discharged from hospital 2 days later.
Discussion Rupture of gravid uterus is a serious pregnancy complication that can be associated with maternal and fetal mortality and is relatively common in low-income countries (Ozdemir et al. 2005). Most uterine ruptures in low-income countries occur following labour obstruction and lack of access to operative delivery (Kadowa 2010). We found 15 reports (Table I) among cases of uterine rupture in the 1st trimester, reported from 1989 onwards. The most common causes of uterine rupture in these 15 cases was placenta percreta (four cases) followed by scar pregnancy and caesarean scar (each three cases). Other causes were cervical pregnancy, myomectomy, misoprostol administration and uterine anomaly (bicornuate uterus). However, the aetiology of uterine rupture was unknown in one case (Table I). In our patient, the most likely predisposing factor for uterine rupture may have been the uterine curettage because it was the most recent gynaecological procedure performed in our patient 6 months prior to the uterine rupture. However, as the rupture occurred exactly on the previous CS incision, that may have been the major cause of the rupture and the D&C may have had no direct role. Uterine curettage may cause uterine synechiae but is not identified as a risk factor for spontaneous gravid uterine rupture. However, D&C has been indicated as a risk factor for a uterine scar (Yu et al. 2008). The other possibility is that the patient had a perforation during the uncomplicated curettage procedure and consequently developed an invisible uterine wall defect that was not diagnosed in her 1st trimester sonography. Uterine rupture usually occurs in the 3rd trimester of pregnancy (in the presence of its related risk factors) and following administration of high doses of uterotonic drugs, such as oxytocin and thus spontaneous rupture of the uterus in the 1st trimester of pregnancy is extremely rare. However, it has been hypothesised that all uterine ruptures in the 1st trimester of pregnancy occur due to the scar pregnancy and implantation of the trophoblast on the previous scar (Shaikh et al. 2012). In contrast to this statement, our case was not scar pregnancy, although uterine rupture occurred in the 1st trimester. In conclusion, in each pregnant woman with severe and sudden abdominal pain and unstable vital signs in the 1st trimester of pregnancy and history of previous uterine surgery, the diagnosis of uterine rupture should be considered. It seems that simultaneous existence of two or more risk factors predispose the uterus to the risk of early rupture at the 1st trimester of pregnancy. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
200
Obstetrics Case Reports Table I. Cases of uterine rupture in the 1st trimester of pregnancy. Author and date
J Obstet Gynaecol Downloaded from informahealthcare.com by University of Bristol on 03/03/15 For personal use only.
Marcellus et al. (1989) Ozeren et al. (1997) Ito et al. (1998) Liang et al. (2003) Matsuo et al. (2004) Esmans et al. (2004) Kimb et al. (2005) Park et al. (2005) Dabulis and McGuirk (2007) Ismail and Toon (2007) Sliutz et al. (2009) Jang et al. (2011) Ijaz et al. (2011) Shaikh et al. (2012) Tola (2014)
Journal
Cause of uterine rupture
Irish Journal of Medical Science Israel Journal of Medical Sciences Journal of Medicine Journal of Reproductive Medicine Journal of Obstetrics and Gynaecology Research Human Reproduction Reproductive Toxicology Journal of Korean Medical Science Journal of Emergency Medicine Journal of Obstetrics and Gynaecology Medical Hypotheses International Journal of Medical Sciences Journal of Obstetrics and Gynaecology Quarterly Medical Channel Case Reports in Obstetrics and Gynecology
Cervical pregnancy Previous traditional myomectomy Scar pregnancy Placenta percreta Caesarean scar Placenta percreta Misoprostol administration Unknown Placenta percreta Caesarean scar Scar pregnancy Placenta percreta Caesarean scar Scar ectopic pregnancy Uterine anomaly (bicornuate uterus)
References Dabulis SA, McGuirk TD. 2007. An unusual case of hemoperitoneum: uterine rupture at 9 weeks gestational age. Journal of Emergency Medicine 33:285–287. Dow M, Wax JR, Pinette MG et al. 2009. Third-trimester uterine rupture without previous cesarean: a case series and review of the literature. American Journal of Perinatology 26:739–744. Esmans A, Gerris J, Corthout E et al. 2004. Placenta percreta causing rupture of an unscarred uterus at the end of the first trimester of pregnancy: case report. Human Reproduction 19:2401–2403. Ijaz S, Mahendru A, Sanderson D. 2011. Spontaneous uterine rupture during the 1st trimester: a rare but life-threatening emergency. Journal of Obstetrics and Gynaecology 31:772. Ismail SI, Toon PG. 2007. First trimester rupture of previous caesarean section scar. Journal of Obstetrics and Gynaecology 27:202–204. Ito M, Nawa T, Mikamo H et al. 1998. Lower segment uterine rupture related to early pregnancy by in vitro fertilization and embryo transfer after a previous cesarean delivery. Journal of Medicine 29:85–91. Jang DG, Lee GSR, Yoon JH et al. 2011. Placenta percreta-induced uterine rupture diagnosed by laparoscopy in the first trimester. International Journal of Medical Sciences 8:424–427. Kadowa I. 2010. Ruptured uterus in rural Uganda: prevalence, predisposing factors and outcomes. Singapore Medical Journal 51:35–38. Kimb JO, Hana JY, Choi JS et al. 2005. Oral misoprostol and uterine rupture in the first trimester of pregnancy: A case report. Reproductive Toxicology 20:575–577. Landon MB, Hauth JC, Leveno KJ et al. 2004. Maternal and perinatal outcomes associated with a trial of labour after prior cesarean delivery. New England Journal of Medicine 351:2581–2259. Landon MB. 2010. Predicting uterine rupture in women undergoing trial of labour after prior cesarean delivery. Seminar in Perinatology 34:267–271. Liang HS, Jeng CJ, Sheen TC et al. 2003. First-trimester uterine rupture from a placenta percreta. A case report. Journal of Reproductive Medicine 48: 474–478. Marcellus M, Jenkins DM, Keohane C. 1989. Intra abdominal rupture of first trimester cervical pregnancy. Irish Journal of Medical Sciences 158:20–21. Matsuo K, Shimoya K, Shinkai T et al. 2004. Uterine rupture of cesarean scar related to spontaneous abortion in the first trimester. Journal of Obstetrics and Gynaecology Research 30:34–36. Nkwabong E, Kouam L, Takang W. 2007. Spontaneous uterine rupture during pregnancy: case report and review of literature. African Journal of Reproductive Health 11:107–112. Ofir K, Sheiner E, Levy A et al. 2003. Uterine rupture: risk factors and pregnancy outcome. American Journal of Obstetrics and Gynecology 189:1042–1046. Ozdemir I, Yucel N, Yucel O. 2005. Rupture of the pregnant uterus: a 9-year review. Archives of Gynecology and Obstetrics 272:229–231. Ozeren M, Ulusoy M, Uyanik E. 1997. First-trimester spontaneous uterine rupture after traditional myomectomy: case report. Israeli Journal of Medical Sciences 33:752–753. Park YJ, Ryu KY, Lee JI et al. 2005. Spontaneous uterine rupture in the first trimester: a case report. Journal of Korean Medical Science 20:1079–1081. Shaikh S, Shaikh NB, Channa S et al. 2012. First trimester uterine rupture due to scar ectopic pregnancy. Quarterly Medical Channel 19:68–70. Singh A, Jain S. 2000. Spontaneous rupture of unscarred uterus in early pregnancy: a rare entity. Acta Obstetrica et Gynecologica Scandinavica 79:431–432. Sliutz G, Sanani R, Spängler-Wierrani B et al. 2009. First trimester uterine rupture and scar pregnancy. Medical Hypotheses 73:326–327.
Tola EN. 2014. First trimester spontaneous uterine rupture in a young woman with uterine anomaly. Case Reports in Obstetrics and Gynecology 2014:967386. Yu D, Wong YM, Cheong Y et al. 2008. Asherman syndrome – one century later. Fertility and Sterility 89:759–779.
A case of successful perinatal outcome and management of microinvasive cervical cancer diagnosed in the 3rd trimester of pregnancy S. P. Lee, S. Y. Kim, H. N. Park & J. W. Shin Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University, Incheon, Korea DOI: 10.3109/01443615.2014.940292 Correspondence: J. W. Shin, Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University, 1198 Guwal-Dong, Namdong-Gu, Incheon 405-760, Korea. E-mail: [email protected]
Introduction Planning for treatment of cervical neoplasia in pregnancy requires consideration of both the disease and the fetal outcome. In the absence of invasive cancer, conservative management is generally recommended (Coppolillo et al. 2013; Frega et al. 2007; Massad et al. 2013; Murta et al. 2002). Intraoperative bleeding, abortion and preterm delivery have been reported as complications of conisation during pregnancy (Dunn et al. 2003; Robova et al. 2005; Seki et al. 2010). The authors report on a case of microinvasive cervical cancer diagnosed in the 3rd trimester of pregnancy by conisation and treated by caesarean section and simple hysterectomy.
Case report A 33-year-old woman in early pregnancy visited the gynaecological oncology unit, with a high-grade squamous intraepithelial lesion (HSIL) on cervical cytology diagnosed by her O&G doctor in the primary clinic. A colposcopy directed cervical biopsy performed at the gestational age of 12 weeks showed cervical intraepithelial neoplasia (CIN) 3. The patient was advised to undergo re-evaluation of the disease at 6 weeks postpartum and to continue antenatal care and cervical cytology with her O&G doctor in the primary clinic. The patient presented at the gestational age of 31 weeks, with a histological report of suspicious microinvasive cervical cancer diagnosed by her O&G doctor in the primary clinic. After review of the slide by a pathology specialist, microinvasive cervical cancer was confirmed and cervical conisation was planned for staging of cervical cancer.
OBSTETRICS CASE REPORTS
Spontaneous rupture of the uterus during the 1st trimester of pregnancy M. Bandarian1 & F. Bandarian2 1Hazrat Zahra Hospital, Qom University of Medical Sciences, Qom and 2Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
J Obstet Gynaecol Downloaded from informahealthcare.com by University of Bristol on 03/03/15 For personal use only.
DOI: 10.3109/01443615.2014.937334 Correspondence: M. Bandarian, Hazrat Zahra Hospital, Qom University of Medical Sciences, Qom, Iran. E-mail: [email protected]
Introduction The rupture of a gravid uterus describes a full-thickness uterine wall defect, which is a serious pregnancy complication that may be lifethreatening for a mother and her fetus (Dow et al. 2009). Uterine rupture is usually seen in the 3rd trimester of pregnancy and most usually in labour. The incidence of uterine rupture has been reported as between 0.006% and 0.01% in an unscarred uterus and between 0.3% and 1% in those with a previous caesarean section (CS) (Singh and Jain 2000; Landon et al. 2004). There are many conditions associated with increased risk of uterine rupture. Some of these risk factors include: uterine anomalies; fetal anomalies; advanced maternal and gestational age; birth weight ⬎ 4,000 g; use of oxytocin; placenta percreta; multiparity with an inter-delivery interval of ⬍ 18–24 months; tumours (such as malignant mixed mesodermal tumour, müllerian adenofibroma, neuroectodermal tumour and fibroid tumour); previous caesarean section or other uterine surgeries and uterine curettage, of which, previous uterine surgery is the most common risk factor (Ofir et al. 2003; Nkwabong et al. 2007; Landon 2010). Here, we present a case of spontaneous uterine rupture in the 1st trimester, with complete expulsion of the gestational sac, fetus and placenta into the abdominal cavity.
Case report
A 30-year old G4P2 ⫹ 1 pregnant woman was referred as an emergency with sudden onset of severe abdominal pain of 2 h duration. The pain was persistent and accompanied by nausea and vomiting. There was no vaginal bleeding. Based on the 1st trimester sonography, performed at 9 weeks and 1 day, gestational age was estimated to be 11 weeks and 3 days and a singleton pregnancy. She had a history of two caesarean sections (both of them were lower segment CS) and her most recent pregnancy ended in spontaneous miscarriage, which was managed by dilatation and curettage (D&C) 6 months earlier. There was no report of uterine perforation at the D&C. In the physical examination, abdominal distention and tenderness of the lower abdomen were identified. The patient was pale and her pulse rate and blood pressure were 120/min and 85/60 mmHg, respectively. The patient developed orthostatic hypotension in the emergency ward. Intravenous access and urinary catheter were given; the urine output was 100 ml. After this, the patient was initially resuscitated with 2,000 ml Ringer’s solution. The results of her primary laboratory tests were as follows: Hb: 130 g/l; Plt count: 55,000; PT: 13; PTT: 26; INR: 1.1 and fibrinogen: 2.02 g/l.
Emergency abdominal sonography was performed. The image of a live fetus with CRL of 32 mm in the uterine cavity and a subchorionic haematoma of 39 ⫻ 18 mm adjacent to it was seen in the uterus. The placenta was not anterior. There was a large amount of free fluid in the pelvis and abdomen. Based on these clinical, laboratory and sonographic findings, an emergency laparotomy was performed. At laparotomy, approximately 1,500 ml blood, a 1,000 ml clot and an intact gestational sac with a dead fetus that had already been extruded from the uterus into the peritoneal cavity were observed in the abdominal cavity. The uterine rupture occurred exactly on the previous CS incision site. Two units of packed red cells were infused during surgery. The uterine incision was repaired and closed. The patient had no postoperative complications and was discharged from hospital 2 days later.
Discussion Rupture of gravid uterus is a serious pregnancy complication that can be associated with maternal and fetal mortality and is relatively common in low-income countries (Ozdemir et al. 2005). Most uterine ruptures in low-income countries occur following labour obstruction and lack of access to operative delivery (Kadowa 2010). We found 15 reports (Table I) among cases of uterine rupture in the 1st trimester, reported from 1989 onwards. The most common causes of uterine rupture in these 15 cases was placenta percreta (four cases) followed by scar pregnancy and caesarean scar (each three cases). Other causes were cervical pregnancy, myomectomy, misoprostol administration and uterine anomaly (bicornuate uterus). However, the aetiology of uterine rupture was unknown in one case (Table I). In our patient, the most likely predisposing factor for uterine rupture may have been the uterine curettage because it was the most recent gynaecological procedure performed in our patient 6 months prior to the uterine rupture. However, as the rupture occurred exactly on the previous CS incision, that may have been the major cause of the rupture and the D&C may have had no direct role. Uterine curettage may cause uterine synechiae but is not identified as a risk factor for spontaneous gravid uterine rupture. However, D&C has been indicated as a risk factor for a uterine scar (Yu et al. 2008). The other possibility is that the patient had a perforation during the uncomplicated curettage procedure and consequently developed an invisible uterine wall defect that was not diagnosed in her 1st trimester sonography. Uterine rupture usually occurs in the 3rd trimester of pregnancy (in the presence of its related risk factors) and following administration of high doses of uterotonic drugs, such as oxytocin and thus spontaneous rupture of the uterus in the 1st trimester of pregnancy is extremely rare. However, it has been hypothesised that all uterine ruptures in the 1st trimester of pregnancy occur due to the scar pregnancy and implantation of the trophoblast on the previous scar (Shaikh et al. 2012). In contrast to this statement, our case was not scar pregnancy, although uterine rupture occurred in the 1st trimester. In conclusion, in each pregnant woman with severe and sudden abdominal pain and unstable vital signs in the 1st trimester of pregnancy and history of previous uterine surgery, the diagnosis of uterine rupture should be considered. It seems that simultaneous existence of two or more risk factors predispose the uterus to the risk of early rupture at the 1st trimester of pregnancy. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
200
Obstetrics Case Reports Table I. Cases of uterine rupture in the 1st trimester of pregnancy. Author and date
J Obstet Gynaecol Downloaded from informahealthcare.com by University of Bristol on 03/03/15 For personal use only.
Marcellus et al. (1989) Ozeren et al. (1997) Ito et al. (1998) Liang et al. (2003) Matsuo et al. (2004) Esmans et al. (2004) Kimb et al. (2005) Park et al. (2005) Dabulis and McGuirk (2007) Ismail and Toon (2007) Sliutz et al. (2009) Jang et al. (2011) Ijaz et al. (2011) Shaikh et al. (2012) Tola (2014)
Journal
Cause of uterine rupture
Irish Journal of Medical Science Israel Journal of Medical Sciences Journal of Medicine Journal of Reproductive Medicine Journal of Obstetrics and Gynaecology Research Human Reproduction Reproductive Toxicology Journal of Korean Medical Science Journal of Emergency Medicine Journal of Obstetrics and Gynaecology Medical Hypotheses International Journal of Medical Sciences Journal of Obstetrics and Gynaecology Quarterly Medical Channel Case Reports in Obstetrics and Gynecology
Cervical pregnancy Previous traditional myomectomy Scar pregnancy Placenta percreta Caesarean scar Placenta percreta Misoprostol administration Unknown Placenta percreta Caesarean scar Scar pregnancy Placenta percreta Caesarean scar Scar ectopic pregnancy Uterine anomaly (bicornuate uterus)
References Dabulis SA, McGuirk TD. 2007. An unusual case of hemoperitoneum: uterine rupture at 9 weeks gestational age. Journal of Emergency Medicine 33:285–287. Dow M, Wax JR, Pinette MG et al. 2009. Third-trimester uterine rupture without previous cesarean: a case series and review of the literature. American Journal of Perinatology 26:739–744. Esmans A, Gerris J, Corthout E et al. 2004. Placenta percreta causing rupture of an unscarred uterus at the end of the first trimester of pregnancy: case report. Human Reproduction 19:2401–2403. Ijaz S, Mahendru A, Sanderson D. 2011. Spontaneous uterine rupture during the 1st trimester: a rare but life-threatening emergency. Journal of Obstetrics and Gynaecology 31:772. Ismail SI, Toon PG. 2007. First trimester rupture of previous caesarean section scar. Journal of Obstetrics and Gynaecology 27:202–204. Ito M, Nawa T, Mikamo H et al. 1998. Lower segment uterine rupture related to early pregnancy by in vitro fertilization and embryo transfer after a previous cesarean delivery. Journal of Medicine 29:85–91. Jang DG, Lee GSR, Yoon JH et al. 2011. Placenta percreta-induced uterine rupture diagnosed by laparoscopy in the first trimester. International Journal of Medical Sciences 8:424–427. Kadowa I. 2010. Ruptured uterus in rural Uganda: prevalence, predisposing factors and outcomes. Singapore Medical Journal 51:35–38. Kimb JO, Hana JY, Choi JS et al. 2005. Oral misoprostol and uterine rupture in the first trimester of pregnancy: A case report. Reproductive Toxicology 20:575–577. Landon MB, Hauth JC, Leveno KJ et al. 2004. Maternal and perinatal outcomes associated with a trial of labour after prior cesarean delivery. New England Journal of Medicine 351:2581–2259. Landon MB. 2010. Predicting uterine rupture in women undergoing trial of labour after prior cesarean delivery. Seminar in Perinatology 34:267–271. Liang HS, Jeng CJ, Sheen TC et al. 2003. First-trimester uterine rupture from a placenta percreta. A case report. Journal of Reproductive Medicine 48: 474–478. Marcellus M, Jenkins DM, Keohane C. 1989. Intra abdominal rupture of first trimester cervical pregnancy. Irish Journal of Medical Sciences 158:20–21. Matsuo K, Shimoya K, Shinkai T et al. 2004. Uterine rupture of cesarean scar related to spontaneous abortion in the first trimester. Journal of Obstetrics and Gynaecology Research 30:34–36. Nkwabong E, Kouam L, Takang W. 2007. Spontaneous uterine rupture during pregnancy: case report and review of literature. African Journal of Reproductive Health 11:107–112. Ofir K, Sheiner E, Levy A et al. 2003. Uterine rupture: risk factors and pregnancy outcome. American Journal of Obstetrics and Gynecology 189:1042–1046. Ozdemir I, Yucel N, Yucel O. 2005. Rupture of the pregnant uterus: a 9-year review. Archives of Gynecology and Obstetrics 272:229–231. Ozeren M, Ulusoy M, Uyanik E. 1997. First-trimester spontaneous uterine rupture after traditional myomectomy: case report. Israeli Journal of Medical Sciences 33:752–753. Park YJ, Ryu KY, Lee JI et al. 2005. Spontaneous uterine rupture in the first trimester: a case report. Journal of Korean Medical Science 20:1079–1081. Shaikh S, Shaikh NB, Channa S et al. 2012. First trimester uterine rupture due to scar ectopic pregnancy. Quarterly Medical Channel 19:68–70. Singh A, Jain S. 2000. Spontaneous rupture of unscarred uterus in early pregnancy: a rare entity. Acta Obstetrica et Gynecologica Scandinavica 79:431–432. Sliutz G, Sanani R, Spängler-Wierrani B et al. 2009. First trimester uterine rupture and scar pregnancy. Medical Hypotheses 73:326–327.
Tola EN. 2014. First trimester spontaneous uterine rupture in a young woman with uterine anomaly. Case Reports in Obstetrics and Gynecology 2014:967386. Yu D, Wong YM, Cheong Y et al. 2008. Asherman syndrome – one century later. Fertility and Sterility 89:759–779.
A case of successful perinatal outcome and management of microinvasive cervical cancer diagnosed in the 3rd trimester of pregnancy S. P. Lee, S. Y. Kim, H. N. Park & J. W. Shin Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University, Incheon, Korea DOI: 10.3109/01443615.2014.940292 Correspondence: J. W. Shin, Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University, 1198 Guwal-Dong, Namdong-Gu, Incheon 405-760, Korea. E-mail: [email protected]
Introduction Planning for treatment of cervical neoplasia in pregnancy requires consideration of both the disease and the fetal outcome. In the absence of invasive cancer, conservative management is generally recommended (Coppolillo et al. 2013; Frega et al. 2007; Massad et al. 2013; Murta et al. 2002). Intraoperative bleeding, abortion and preterm delivery have been reported as complications of conisation during pregnancy (Dunn et al. 2003; Robova et al. 2005; Seki et al. 2010). The authors report on a case of microinvasive cervical cancer diagnosed in the 3rd trimester of pregnancy by conisation and treated by caesarean section and simple hysterectomy.
Case report A 33-year-old woman in early pregnancy visited the gynaecological oncology unit, with a high-grade squamous intraepithelial lesion (HSIL) on cervical cytology diagnosed by her O&G doctor in the primary clinic. A colposcopy directed cervical biopsy performed at the gestational age of 12 weeks showed cervical intraepithelial neoplasia (CIN) 3. The patient was advised to undergo re-evaluation of the disease at 6 weeks postpartum and to continue antenatal care and cervical cytology with her O&G doctor in the primary clinic. The patient presented at the gestational age of 31 weeks, with a histological report of suspicious microinvasive cervical cancer diagnosed by her O&G doctor in the primary clinic. After review of the slide by a pathology specialist, microinvasive cervical cancer was confirmed and cervical conisation was planned for staging of cervical cancer.
