Nėštumas ir gimdymas po laparoskopinės miomektomijos. Klinikinis atvejis ir literatūros apžvalga

Uterine rupture is a “close to death” condition for both the mother and her foetus. It is usually seen during labour induction in a scarred uterus. Spontaneous rupture of the uterus in the second or third trimester before labour is a very rare but dramatic condition. Here, we report a successful case of uterine scar dissection presented in 25 weeks of gestation but prolonged till 36 weeks for the women with a history of infertility and laparoscopic myomectomy in uterus with leiomyomata. Ultrasonographic and perioperative data are presented suggesting multiple uterine wall transformations in the second and third trimester that may lead to scar dissidence and rupture. Laparoscopic myomectomy has advantages over laparotomy in the management of infertility but the possibility of uterine rupture in following pregnancies should not be underestimated. Therefore, repair of the myometrium should be carefully assessed. Timing of the termination of pregnancy in the scarred uterus after myomectomy that differ from scarred uterus after caesarean section is discussed. Pregnancy outcome depending on myomas and possible tactics before and after myomectomy are explored.