Late complications of operative hysteroscopy: predicting patients at risk of uterine rupture during subsequent pregnancy.

The main purpose of this study was to identify predictors of uterine rupture following operative hysteroscopy. We also attempted to assess possible clinical or imaging methods in order to detect and avoid impending ruptures. A MEDLINE and EMBASE search of the English, German and French literatures was performed to retrieve case reports of uterine rupture following operative hysteroscopy. A total of 14 cases were retrieved. Twelve patients had a history of hysteroscopic metroplasty. Uterine perforation complicated operative hysteroscopy in eight cases and electrosurgery was used in nine cases. The interval between hysteroscopy and subsequent pregnancies varied from 1 month to 5 years with an average range of 16 months. Hysterosalpingogram follow-up was carried out in six cases and was considered normal in five cases. During pregnancy, serial ultrasound scans were performed in two cases to detect impeding rupture without success. Hysteroscopic metroplasty subjected patients to high risks of uterine rupture during subsequent pregnancies. Uterine perforation and/or the use of electrosurgery increase this risk but are not considered an independent risk factor. Uncomplicated hysteroscopic resection of submucous myomas and endometrial polyps did not alter obstetrical outcome. Apart from favourable use of scissors for hysteroscopic metroplasty, no accurate methods to prevent or detect impending ruptures in subsequent pregnancies were found. Physicians providing care for patients with previous hysteroscopic metroplasty or complicated operative hysteroscopy, should be aware of the potential risks for uterine rupture during pregnancy.

Colouterine fistula complicating diverticulitis: a case report and review of the literature.

Colouterine fistula, secondary to diverticulitis, is an extremely rare complication, and only few cases have been reported in the literature. We report the case of 76-year-old woman, who presented with vaginal discharge over a three-month period. Pelvic examination and laboratory investigations suggested a colouterine fistula, that was confirmed by non-invasive imaging. Surgical treatment was a one-stage, en bloc resection of the uterus and sigmoid colon. In the presence of severe inflammatory reaction or paracolic abscess, a two-stage procedure should be safer. Otherwise, a one-stage procedure, en bloc resection of the uterus and sigmoid colon is preferred, as we cannot rule out a malignancy prior to surgery.

Subarachnoid hemorrhage due to cerebral aneurysmal rupture during pregnancy.

Cerebral aneurysmal complications rarely occur during pregnancy. Telling the difference between eclampsia and cerebral hemorrhage due to aneurysmal rupture can prove to be difficult. Aneurysmal management should be performed in an emergency but fetal prognosis should be considered. We report a series of eight pregnant women presenting aneurysmal complications and we have assessed their management and outcome. Both maternal and perinatal mortality rates were correlated with the maternal clinical score. We stress the role of combined care by both neurosurgeons and obstetricians. An emergency cesarean section followed by aneurysmal treatment appears to be a widely accepted strategy in pregnant women with cerebral aneurysmal complications.

Case report: a prenatal case of Jarcho-Levin syndrome diagnosed during the first trimester of pregnancy.

The Jarcho-Levin syndrome is a specific form of spondylocostal/spondylothoracic dysostosis. There have been various classifications of this syndrome. We present the case of a severe prenatal Jarcho-Levin syndrome, diagnosed by ultrasound examination during the first trimester of pregnancy in a family with no previous medical history of an affected child. X-ray exploration, high-resolution spiral computed tomography and autopsy confirmed the diagnosis.

Fetal fibrochondrogenesis at 26 weeks' gestation.

Fibrochondrogenesis is a rare and lethal osteochondrodysplasia with an autosomal recessive mode of inheritance. We report a male fetus in which the diagnosis of lethal osteochondrodysplasia was suspected on prenatal ultrasound and radiological examinations during the second trimester of pregnancy. After termination of pregnancy, fibrochondrogenesis was diagnosed by radiological examination and histological study of fetal bones. Interwoven fibrous septa and fibroblastic degeneration of chondrocytes are pathognomonic. The recurrence rate is 25% and accurate diagnosis is necessary to enable genetic counselling.