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Laparoscopic Management of Uterine Rupture After Early Second-Trimester Medical Abortion in a Patient With a Prior
Ahmed Namazov1, Leonti Grin1, Michael Volodarsky1
1Department of Obstetrics and Gynecology, Barziali Medical Center, Ben-Gurion University, Ashkelon, Israel.
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.
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