DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20175295

Successful outcome of a triplet pregnancy following laparoscopic myomectomy for infertility: a unique case report

Kaliki Hymavathi, Surekha Tadisetti, Malini Devi Gottipati, Bhavana T. C.

Abstract


Infertility is a burning problem affecting 10-15% of the couples globally. The female factors contribute to about 40- 45% among which uterine factor is up to 10%. Presence of uterine myomas also significantly contribute to infertility. A conservative surgical approach like myomectomy is indicated for women in reproductive age both for psychological reasons as well as to preserve their reproductive potential. In recent years laparoscopic myomectomy (LM) has become the procedure of choice. Pregnancy outcome after myomectomy is a more significant concern especially with regard to the obstetric calamity of sudden uterine rupture due to the presence of an operative scar. The intensity of such complication will be considerably high when a triplet pregnancy occurs with a LM scar in the upper uterine segment with history of uterine cavity being opened during the myomectomy surgery. Managing such a case will be a difficult task to the attending clinician posing many unexpected clinical dilemmas. We are reporting a unique case of triplet pregnancy occurred following a LM resulting in successful maternal and fetal outcome. During the course of this pregnancy apart from considerable maternal distress due to uterine over distension many clinical problems like cervical insufficiency, pre eclampsia, polyhydraminos, intrauterine growth restriction (IUGR) and last but not the least severe postpartum haemorrhage (PPH) have been encountered and could be managed efficiently. An elective Caesarean section was performed at 33+4 weeks gestation delivering live triplets. Mother and all the three babies discharged from the hospital in good condition.


Keywords


Infertility, Laparoscopic myomectomy, Triplet pregnancy

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References


Seshadri L. Infertility. Essential of Gynecology. 2nd ed. Wolters Kluwer Health;2017:305-6.

Campo S, Campo V, Gambadauro P. Reproductive outcome before and after laparoscopic or abdominal myomectomy for subserous or intramural myomas. Eur J Obstet Gynecol Reprod Biol. 2003 Oct 10;110(2):215-9.

Dubuisson JB, Chapron C, Chavat X, Morice P. Uterine rupture during pregnancy after laparoscopic myomectomy. Hum Reprod. 1995;10:1475-7.

Harris WJ. Uterine dehiscence following laparoscopic myomectomy. Obstet Gynecol. 1992;80:545.

Dubuisson JB, Chapron C, Fauconnier A, Babaki-Fard K. Laparoscopic myomectomy fertility results: Ann NY Acad Sci. 2001;943:269-75.

Hasson HM, Rotman C, Rana N, Sistos F, Dmowski WP. Laparoscopic myomectomy. Obstet Gynecol. 1992;80:884-8.

Whittaker MD, Garry R. Patient satisfaction with laparoscopic-assisted removal of large myomas. J Am Assoc Gynecol Laparosc. 1996;3(4,supplement):S55.

Paul PG, Koshy AK, Thomas T. Pregnancy outcomes following laparoscopic myomectomy and single-layer myometrial closure. Hum Reprod. 2006;21(12):3278-81.

Uthman OA, Uthman MB, Yahaya I. A population-based study of effect of multiple birth on infant mortality in Nigeria. BMC Pregnancy Childbirth. 2008;8:41.

Seinera P, Farina C, Todros T. Laparoscopic myomectomy and subsequent pregnancy: results in 54 patients. Human Reprod. 2000 Sep 1;15(9):1993-6.

Claeys J, Hellendoorn IN, Hamerlynck T, Bosteels J, Weyers S. The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis. Gynecological Surg. 2014 Aug 1;11(3):197-206.

Deale HS. A review of 367 triplet pregnancies. South Afr Med J. 1984 Jul 1;66(3):92-4.

Nezhat F, Seidman DS, Nezhat C, Nezhat CH. Laparoscopic myomectomy today: Why, when and for whom?. Human Reprod. 1996 May 1;11(5):933-4.