Journal of Nippon Medical School: Vol.71 No.1 page.069

Journal of Nippon Medical School

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ArticleTitle A Case Report: Change in Fetal Heart Rate Pattern on Spontaneous Uterine Rupture at 35 Weeks Gestation after Laparoscopically Assisted Myomectomy

AuthorList Hirobumi Asakura¹, Toshimitsu Oda², Yutaka Tsunoda², Takashi Matsushima¹, Hisayuki Kaseki¹ and Toshiyuki Takeshita¹

Affiliation ¹Department of Obstetrics and Gynecology, Nippon Medical School Second Hospital
²Central Ladies Clinic

Language EN

Volume 71

Issue 1

Year 2004

Page 69-72

Received May 14, 2003

Accepted August 11, 2003

Keywords uterine rupture, laparoscopic myomectomy, pregnancy

Abstract A 31-year-old nulligravid woman who underwent laparoscopically assisted myomectomy 5 months before becoming pregnant suffered uterine rupture at 35 weeks gestation. A 50 g intramusclar myomatous node had been removed laparoscopically. Early signs of rupture included sudden onset of severe abdominal tenderness and frequent uterine contractions despite reassuring FHR tracing. Variable deceleration was observed as late as 7.5 hours after onset. Emergency cesarean section was performed due to increasing severity of tenderness, revealing complete uterine rupture at the fundus site without extrusion of the fetus or placenta. A male neonate (2,860 g) was delivered without asphyxia and an Apgar score of 8. Total volume of hemorrahge was approximately 50 ml. The ruptured uterine wall was repaired by suturing in 2 layers. The present case indicates that sudden onset of abdominal tenderness in pregnant women with a history of laproscopic myomectomy may suggest uterine rupture even in the presence of reassuring FHR. This is a rare case, as non-reassuring FHR patterns generally appear in the late stages of uterine rupture.

Correspondence to Correspondence to Hirobumi Asakura, Department of Obstetrics and Gynecology, Nippon Medical School Second Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
morgen@nms.ac.jp

ArticleTitle	A Case Report: Change in Fetal Heart Rate Pattern on Spontaneous Uterine Rupture at 35 Weeks Gestation after Laparoscopically Assisted Myomectomy
AuthorList	Hirobumi Asakura¹, Toshimitsu Oda², Yutaka Tsunoda², Takashi Matsushima¹, Hisayuki Kaseki¹ and Toshiyuki Takeshita¹
Affiliation	¹Department of Obstetrics and Gynecology, Nippon Medical School Second Hospital ²Central Ladies Clinic
Language	EN
Volume	71
Issue	1
Year	2004
Page	69-72
Received	May 14, 2003
Accepted	August 11, 2003
Keywords	uterine rupture, laparoscopic myomectomy, pregnancy
Abstract	A 31-year-old nulligravid woman who underwent laparoscopically assisted myomectomy 5 months before becoming pregnant suffered uterine rupture at 35 weeks gestation. A 50 g intramusclar myomatous node had been removed laparoscopically. Early signs of rupture included sudden onset of severe abdominal tenderness and frequent uterine contractions despite reassuring FHR tracing. Variable deceleration was observed as late as 7.5 hours after onset. Emergency cesarean section was performed due to increasing severity of tenderness, revealing complete uterine rupture at the fundus site without extrusion of the fetus or placenta. A male neonate (2,860 g) was delivered without asphyxia and an Apgar score of 8. Total volume of hemorrahge was approximately 50 ml. The ruptured uterine wall was repaired by suturing in 2 layers. The present case indicates that sudden onset of abdominal tenderness in pregnant women with a history of laproscopic myomectomy may suggest uterine rupture even in the presence of reassuring FHR. This is a rare case, as non-reassuring FHR patterns generally appear in the late stages of uterine rupture.
Correspondence to	Correspondence to Hirobumi Asakura, Department of Obstetrics and Gynecology, Nippon Medical School Second Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan morgen@nms.ac.jp