22 feb. RUPTURA UTERINĂ ASIMPTOMATICĂ LA O GRAVIDĂ CU MIOMECTOMIE LAPAROSCOPICĂ ÎN ANTECEDENTE. PREZENTARE DE CAZ
R. Chicea*, F. Ispăşoiu**
* Clinica Obstetrică-Ginecologie Sibiu
** Clinica Polisano Sibiu
Rezumat
Ruptura uterina este o complicatie obstetricala rara dar potential catastrofala cu o morbiditate si mortalitate fetala si materna ridicate care apare cel mai frecvent la gravide cu cicatrici uterine. Una dintre cauzele de aparitie a unei cicatrici uterine este si miomectomia, care poate fi realizata prin abord clasic sau laparoscopic. Lucrarea de fata prezinta cazul unei gravide la termen la care cu ocazia nasterii prin sectiune cezariana s-a descoperit prezenta unei rupturi uterine asimptomatice de cca 4 cm aparuta pe locul unei miomectomii laparoscopice suferite in antecedente..
Laparoscopia prezinta avantajul unei abordari minim invazive cu recuperare rapida dar fara a fi lipsita de riscuri. Aparitia rupturii uterine dupa miomectomie laparoscopica este incidentala si tine de localizarea miomului, calitatea suturii, timpul scurs de la interventie si aparitia sarcinii. Gravidele cu cicatrice uterina trebuie monitorizate atent datorita aparitiei rupturii uterine asimptomatice
Abstract – Uterin rupture after laparoscopic myomectomy
Uterine rupture is a relatively uncommon but potentially devastating obstetric complication with high fetal and maternal morbidity, occurring in most cases on a scarred uterus. Myomectomy is one of the causes of uterine scar and it can be performed by laparotomy or laparoscopy. This study presents the case of a pregnant women with a previous laparoscopic myomectomy who was diagnosed with a 4 cm silent uterine rupture during the caesarean section. Laparocopy is much less invasive than laparotomy with quicker return to normal activity but also with certain risks. The uterine rupture after laparoscopic myomectomy is incidental and it depends on the myoma’s location, the suture’s strength and the interval between surgery and pregnancy. Close monitoring should be performed to all pregnant women with uterine scar.
Keywords: laparoscopy, myoma, pregnancy, uterine rupture
