Repair of the myometrial scar defect at repeat caesarean section: a modified surgical technique

Abstract Background To investigate whether the existing surgical technique for uterine closure at repeat lower segment Caesarean section (LSCS) can be modified to achieve adequate residual myometrial thickness (RMT) to ensure scar integrity and reduce complications in future pregnancy. Methods Women with a significant scar defect at repeat LSCS had the anterior uterine wall closed by a single experienced obstetrician with a technique focused on recognition, mobilisation and apposition of the retracted myometrial edges at the boundary of the defect. This was aimed at anatomical restoration of the lower segment. The RMT at the scar area was assessed by postnatal pelvic ultrasound scan at three months. Results Thirty women with a history of at least one previous CS, incidentally found to have a large defect at operation underwent the technique with prior consent. A postnatal scan showed a mean residual myometrial thickness of 8.4 mm (SD ±1.3 mm; range 5.6–11.0 mm). The average operating time was 91 mins and the average blood loss 728 ml. Two women who underwent the repair have gone on to have a further uneventful CS. Conclusion This modified technique resulted in scan evidence of an RMT indicative of uterine wall stability postnatally and offers the potential for reducing the risk of rupture and placenta accreta spectrum (PAS) in future pregnancy.

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“En Caul” Cesarean Delivery for Extremely Premature Fetuses: Surgical Technique and Anesthetic Options

The Surgery Journal ◽

10.1055/s-0040-1712927 ◽

2020 ◽

Vol 06 (S 02) ◽

pp. S104-S109

Author(s):

Takeshi Murakoshi

Keyword(s):

Surgical Technique ◽

Premature Infant ◽

Cesarean Delivery ◽

Uterine Wall ◽

Lower Segment ◽

Uterine Incision ◽

Uterine Muscle ◽

Vertical Incision ◽

Extremely Premature Infant ◽

Uterine Relaxation

AbstractThe risks and technical difficulties at the cesarean delivery for extremely premature infant under 1,000g are as follows: (1) a premature infant is very weak for pressure of uterine wall or human hands, (2) skin of infant is really premature and weak, (3) uterine wall is thick and difficult to incise at lower segment of uterus, (4) classical vertical incision or reverse T-shape incision are at risk for future uterine rupture, and (5) at the timing of rupture of membrane, uterine wall may contract drastically and the infant is trapped the uterine wall, so called “hug-me-tight-uterus”.To resolve the problems, we use the technique of “En Caul” cesarean delivery with nitroglycerin. Intravenous injection of nitroglycerin just before uterine incision made the rapid and sufficient relaxation of uterine muscle. After getting adequate uterine relaxation, U- or J-shaped incision is made to lower segment of the uterus; however, we never incise the membrane before the infant was delivered. The baby is delivered with wrapped amniotic fluid and the membrane, which protect the infant against the pressure of uterine wall or surgeon’s hands. The infant is gently handled to neonatologist by “En Caul” with the placenta. Neonatologist can make the membrane ruptured and resuscitation. Own blood transfusion can be made through the umbilical cord and placenta, if the infant was anemic or hypovolemic.

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Uterocutaneous Fistula : A Rare Clinical Presentation

TAJ Journal of Teachers Association ◽

10.3329/taj.v25i0.37566 ◽

2018 ◽

Vol 25 ◽

pp. 87-89

Author(s):

M Durrul Huda ◽

M Hafizur Rahman ◽

Shermin Selina Sultana ◽

M Kabiruzzaman Shah ◽

M Mohibul Hasan ◽

...

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Clinical Presentation ◽

Rare Complication ◽

Uterine Wall ◽

Lower Segment ◽

Lower Segment Caesarean Section

A uterocutaneous fistula is a rare clinical presentation that occurs following Cesarean section and other pelvic operations. We report a case of Uterocutaneous fistula which was formed following lower segment caesarean section. USG was helpful in the diagnosis and was treated successfully with fistulectomy and repair of uterine wall. The case highlights the rare complication in caesarean section and diagnosis with USG and experience with its management.TAJ 2012; 25: 87-89

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Intraoperative Phenylephrine Infusion to Reduce Postoperative Shivering in Lower Segment Caesarean Section

Case Medical Research ◽

10.31525/ct1-nct04133961 ◽

2019 ◽

Author(s):

Keyword(s):

Caesarean Section ◽

Lower Segment ◽

Lower Segment Caesarean Section ◽

Phenylephrine Infusion

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Inappropriate surgery in a patient with misdiagnosed Robert’s uterus

BMC Women s Health ◽

10.1186/s12905-021-01404-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Iori Kisu ◽

Kanako Nakamura ◽

Tetsuro Shiraishi ◽

Tomoko Iijima ◽

Moito Iijima ◽

...

Keyword(s):

Quality Of Life ◽

Uterine Wall ◽

Septate Uterus ◽

Case Presentation ◽

Surgical Interventions ◽

Unicornuate Uterus ◽

Uterine Malformation ◽

Mullerian Anomaly ◽

Future Pregnancy

Abstract Background Robert’s uterus is a rare Mullerian anomaly, which can be described as an asymmetric, septate uterus with a non-communicating hemicavity. Herein, we present the case of a misdiagnosed Robert’s uterus, resulting in an invasive and disadvantageous surgery. Case presentation A 16-year-old woman was referred to our department because of dysmenorrhea and suspicion of uterine malformation. We misdiagnosed Robert’s uterus as a unicornuate uterus with a non-communicating rudimentary horn and hematometra, and performed laparoscopic hemi-hysterectomy. Although the patient’s symptoms were relieved, our surgical procedure left the lateral uterine wall weak, making the patient’s uterus susceptible to uterine rupture in any future pregnancy. Conclusions Although the early diagnosis of Robert’s uterus is challenging, it is important in order to determine appropriate surgical interventions and management for maintaining the quality of life and ensuring safety in future pregnancies.

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I315 Caesarean section - The surgical technique

International Journal of Gynecology & Obstetrics ◽

10.1016/s0020-7292(09)60315-5 ◽

2009 ◽

Vol 107 ◽

pp. S78-S78

Author(s):

M. Stark

Keyword(s):

Caesarean Section ◽

Surgical Technique

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Minilaparotomy a Good Option in Specific Cases: A Case Report of Bilateral Ovarian Germ Cell Tumor

Case Reports in Obstetrics and Gynecology ◽

10.1155/2012/589568 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

D. Bolla ◽

N. Deseö ◽

A. Sturm ◽

A. Schöning ◽

C. Leimgruber

Keyword(s):

Acute Abdominal Pain ◽

Adnexal Mass ◽

Past History ◽

Ovarian Tissue ◽

Abdominal Cavity ◽

Operating Time ◽

Expectant Management ◽

Small Incision ◽

Risk Of Rupture ◽

The Right

Mature cystic teratomas (MCTs) of the ovary represent 44% of ovarian neoplasmas. The surgical approach is important in young women especially for the cosmetic results. Nowadays most of the ovarian surgeries can be performed laparoscopically. An alternative between laparoscopy and laparotomy is the minilaparotomy (ML) which can be an interesting option, thanks to the small incision. We report a 39-year-old woman who was referred to our hospital with acute abdominal pain. In her past history the patient had an uncomplicated delivery. During pregnancy a 6 cm bilateral MCT was diagnosed and expectant management was followed. A left-sided ovarial torsion was postulated, and laparoscopic detorsion was performed. To avoid a rupture of the left MCT, the operation was interrupted. To remove the cyst, a ML was done two weeks later. A left-sided salpingo-oophorectomy was performed due to a large cyst including the entire ovary. On the other side, the right dermoid cyst was entirely removed. The advantage of a ML is not only shorter operating time with less learning curve compared to laparoscopy but also the possibility to extract the adnexal mass from the abdominal cavity with lower risk of rupture and in addition the possibility to preserve more ovarian tissue.

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Spontaneous Uterine Rupture in a Preterm Pregnancy following Myomectomy

Case Reports in Obstetrics and Gynecology ◽

10.1155/2016/6195621 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

Claire Sutton ◽

Prue Standen ◽

Jade Acton ◽

Christopher Griffin

Keyword(s):

Abdominal Pain ◽

Caesarean Section ◽

Uterine Rupture ◽

Good Condition ◽

Acute Onset ◽

Uterine Wall ◽

Unusual Presentation ◽

Postoperative Course ◽

Spontaneous Uterine Rupture ◽

History Of

A 44-year-old nulliparous woman was transferred to a tertiary obstetric hospital for investigation of acute onset abdominal pain. She was at gestation of 32 weeks and 2 days with a history of previous laparoscopic fundal myomectomy. An initial bedside ultrasound demonstrated oligohydramnios. Following an episode of increased pain early the following morning, a formal ultrasound diagnosed a uterine rupture with the fetal arm extending through a uterine rent. An uncomplicated classical caesarean section was performed and the neonate was delivered in good condition but with a bruised and oedematous right arm. The neonate was transferred to the Special Care Nursery for neonatal care. The patient had an uncomplicated postoperative course and was discharged home three days following delivery. This is an unusual presentation of uterine rupture following myomectomy where the fetal arm had protruded through the uterine wall.

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