Risks of uterine rupture and recommended route of delivery

Tubouterine implantation was performed with some frequency up until the 1980’s. The two main risks of this corrective surgical procedure are ectopic pregnancy and uterine rupture. Among our patients who have had Essure reversal we have had only one report of an ectopic pregnancy and no patient has reported a uterine rupture as a pregnancy complication.

We advise all of our patients who are undergoing tubal surgery to have early pregnancy monitoring with serum HCG measurements. For our patients who have had bilateral tubouterine implantation, we advise an elective cesarean delivery before the onset of labor to minimize the risk of uterine rupture.

Tubouterine implantation and

risk of rupture of uterus

There are several case reports and a review of the medical literature that have associated uterine rupture with prior tubouterine implantation procedures.^1-3

There is no good information to suggest what the overall increased risk of uterine rupture is for patients who have cornual or fundal incisions during tubouterine implantation.

As a result of the uncertainty of the risk of rupture after tubouterine implantation and because of the seriousness of this complication, we advise all patients who have tubouterine implantation at our center to have an elective cesarean before the onset of labor.

Over a 7 year time period we have had only one report of uterine rupture after Essure reversal surgery.

This occurred at 36 weeks gestation and was diagnosed at the time of cesarean delivery after the patient experienced painful contractions over a 12 hour period. Both mother and baby were healthy. The mother did require a blood transfusion but no other significant complications were encountered.

Timing of cesarean

Most uterine ruptures will occur in the third trimester of pregnancy and the majority of third trimester uterine ruptures will occur during labor. Therefore we recommend an elective cesarean delivery before the onset of labor for our patients who have undergone a tubouterine implantation.

References

1. Shortle B, Jewelewicz R. Uterine rupture following tubal reimplantation. Review of the literature and report of three additional cases. Obstet Gynecol Surv. 1984 Jul;39(7):407-15.
2. Woolam GL, Pratt JH, Wilson RB. Uterine rupture following tubal implantation. Report of 2 cases. Obstet Gynecol. 1967 Mar;29(3):415-9.
3. Whitney DJ, Rivlin ME. A case of rupture of the uterus at the site of tubal implantation. J Obstet Gynaecol Br Commonw. 1966 Oct;73(5):858-60.