卵管間質部妊娠術後の帝王切開術中に子宮破裂を認めた一例

Introduction: Interstitial pregnancies are rare. There have been sporadic reports of postoperative uterine scar rupture; precise frequency is unknown. Herein, we report a case where uterine rupture was observed during a cesarean section after surgery for interstitial ectopic pregnancy. Case: Our 35-year-old patient has had six pregnancies and two deliveries. She was referred to our department with suspected ectopic pregnancy at 7 weeks of gestation. She was diagnosed with right-sided interstitial pregnancy and underwent laparoscopic salpingectomy and interstitial wedge resection. Operative time was 68 minutes; blood volume loss was 9 ml. She conceived spontaneously 18 months postoperatively and underwent elective cesarean section at 37 weeks of gestation. Intraoperatively, mild fundal compression was performed by the assistant during delivery. The newborn weighed 2,512 g; it had an Apgar score of 8/9 points and an umbilical artery pH of 7.233. When the uterus was elevated outside the abdominal cavity after delivery, complete uterine rupture was observed where previous surgery was performed, while the placenta had invaded the abdominal cavity. Uterine rupture was m using double-layer closure. Operative time was 89 minutes; blood volume loss was 607 ml. Postoperative course was uneventful for both mother and newborn. Conclusion: Uterine rupture in pregnancies following surgery for tubal interstitial pregnancy and uterine rupture can also occur during a cesarean section; thus, it is advisable to avoid uterine fundal compression upon delivery, when possible. Additionally, the possibility of uterine rupture after a future pregnancy should be carefully considered during surgery for interstitial ectopic pregnancy.