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Total uterine rupture during pregnancy after an adenomyomectomy

Shingo Ukita, Masafumi Koshiyama, Ayaka Yamaguchi, Masashi Ueda, Masayo Ukita, Kenji Hishikawa, Kazuyo Kakui, Tomoko Kim

Am J Case Rep 2011; 12:106-109

DOI: 10.12659/AJCR.881914

Abstract: Background: Adenomyomectomy and myomectomy are treatment options to reduce dysmenorrhea and to preserve fertility. Recently, the number of adenomyomectomies and myomectomies performed has gradually increased. On the other hand, an increased risk of uterine rupture during pregnancy is associated with the thinned uterine scar after these surgeries.
Case Report: We encountered a 39-year-old nulliparous woman who experienced a spontaneous uterine rupture at an early stage of the 29th week of gestation after an adenomyomectomy. The adenomyomectomy method created a deep and wide wedge-shaped excision. Pathologically, the main reason for the rupture was thought to be the uterine scar with the residual adenomyotic fragments, which was very vulnerable to pregnant decidualization and thus ruptured.
Conclusions: It should be emphasized that a woman who becomes pregnant after undergoing an adenomyomectomy needs very careful management throughout all gestational periods.

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