HISTOPATHIC RUPTURE OF THE UTERUS DURING PREGNANCY

Rupture of the uterus, or a violation of the integrity of its walls, is a severe manifestation of obstetric injury. The decrease in the frequency of uterine ruptures due to mechanical causes, careless obstetric interventions gave way to histopathic organ ruptures due to cesarean section surgery, conservative myomectomy, tubectomy. This publication presents a clinical case of the onset of rupture due to the failure of the suture on the uterus after an ectopic pregnancy in the interstitial section of the fallopian tube, diagnosed at 33 weeks of gestation and culminating in a newborn weighing 2 176 grams, 46 cm long in severe asphyxiation. The case presented is a rare severe obstetric pathology with a high risk of maternal and infant mortality.

Long-term outcome of sphincteroplasty with separate suturing of the internal and the external anal sphincter

Background Sphincteroplasty is one of the treatment options for anal incontinence following obstetric injury. The aim of the study was to evaluate the long-term effect of sphincteroplasty with separate suturing of the internal and the external anal sphincter on anal continence. Methods A retrospective study was conducted on women who had sphincteroplasty for treatment of anal incontinence following obstetric injury. Women operated between January 1, 2011 and December 31, 2014 at Sykehuset Innlandet Hospital Trust Hamar, were invited to answer a questionnaire and participate in a clinical examination, including endoanal sonography. Results 111 (86.7%) women participated. Median postoperative follow-up was 44.5 months, and 63.8% of the participants experienced an improvement of at least three points in the St. Mark’s incontinence score. Fecal urgency and daily fecal leakage persisted in 39.4% and 6.4% of the participants, respectively. The internal anal sphincter improvement persisted in 61.8% of the participants, and there was a median reduction of their St. Mark’s score of 6.0 points between the preoperative value and the value at long-term follow-up. There was no significant change in the St. Mark’s score of patients with persistent dehiscence of the internal anal sphincter. Conclusions Sphincteroplasty, with separate suturing of the internal sphincter resulted in continence for stool maintained for at least 3 years in the majority of the patients, while there was an improvement in continence in nearly two-thirds.