Third-Trimester Uterine Rupture Following Hysteroscopic Septoplasty: The Need for Standardization of Indications

Abstract

Abstract

Background: Hysteroscopic septal resection has become the treatment of choice for women with septate or subseptate uteri because of this procedure's increased safety and efficacy. The indications/benefits for septal resection should be balanced against the risks. This article presents a case that illustrates the potential catastrophe that can result from an intervention performed on a patient with a “soft” indication for this procedure. Case: A second gravida female, whose previous pregnancy was complicated by preeclampsia and fetal death, had a history of hysteroscopic septal resection. At 34 weeks' gestation, she presented with abruptio placenta and subsequently had a uterine rupture after two doses of prostaglandin E₂ gel. She was given a laparotomy to remove the deceased fetus and the ruptured tissues were repaired. Her uterus was conserved. Results: This patient recovered well and was discharged on the ninth postoperative day. She was advised to use contraception for at least 1 year and to make an appointment to be examined early on in her next pregnancy. Conclusions: Although the apparent safety of hysteroscopic septoplasty has prompted some surgeons to liberalize the indications for this procedure, the potential for a catastrophe associated with this procedure should be borne in mind. Strict case selection criteria should be formulated. (J GYNECOL SURG 30:20)