Laparoscopic management of uterine rupture after early second-trimester medical abortion in a patient with a prior cesarean section

Namazov A

Grin L

Volodarsky M

Anteby E

Gemer O

Journal of Minimally Invasive Gynecology
September-October 2016
Sep 2016

STUDY OBJECTIVE:

To show the possibility of laparoscopic management of uterine rupture.  

DESIGN:

Video with explanations.  

SETTING:

In the medical management with misoprostol for termination of pregnancy at any time the risk of uterine rupture may be possible. The risk is likely higher in women with a previous uterus surgery. In a systematic review of available studies, the risk of rupture was .28% among women with a prior cesarean delivery who were undergoing second-trimester misoprostol-induced abortion, meaning if 414 women with a history of cesarean delivery were given misoprostol for second-trimester abortion, 1 would experience uterine rupture. Uterine rupture has only been reported 3 times in first-trimester abortion and only once managed via laparoscopy: a missed abortion reported in 2005, a case of a ruptured unscarred uterus in a women undergoing medical abortion, and a case of a delayed miscarriage at 8 weeks' gestation after misoprostol managed by laparotomy and sharp curettage.  

INTERVENTIONS:

Total laparoscopic management in a patient with uterine tear after misoprostol treatment.  

CONCLUSION:

Early second-trimester medical abortions with misoprostol can cause uterine rupture. In hemodynamically stable cases, total laparoscopic management is possible approach.