|Year : 2021 | Volume
| Issue : 2 | Page : 76-77
Motherhood after hysterectomy: A case report
Pondicherry M Gopinath
Department of Obstetrics, Gynaecology and IVF, SRM Institutes for Medical Sciences, Chennai, India
|Date of Submission||26-Jul-2022|
|Date of Acceptance||14-Oct-2022|
|Date of Web Publication||30-Dec-2022|
Dr. Pondicherry M Gopinath
Department of Obstetrics, Gynaecology and IVF, SRM Institutes for Medical Sciences, No. 1, Jawaharlal Nehru Salai, Vadapalani, Chennai 600026, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Uterine rupture in pregnancy is rare and life-threatening. Myomectomy is one of the common procedures done to enhance success rates in the treatment of subfertile patients. The risk of scar rupture is very high during the third trimester. The rate of total uterine rupture has been reported about 0.07%. This patient was a 33-years-old, seeking motherhood after hysterectomy following a ruptured uterus in the third trimester. Invitro fertilisation stimulation was done, and the embryo transferred to a surrogate mother.
Keywords: IVF after hysterectomy, myomectomy, pregnancy, surrogacy, uterine rupture
|How to cite this article:|
Gopinath PM. Motherhood after hysterectomy: A case report. Onco Fertil J 2021;4:76-7
| Introduction|| |
Women have an ability to procreate life, but unfortunately some women, due to many conditions, are unable to give birth to their own offspring. The word surrogate means substitute. Alternative solutions through invitro fertilisation and surrogacy make it possible for such women to achieve motherhood. Uterine rupture in pregnancy is rare and life-threatening. Myomectomy is one of the common procedures done to enhance success rates in the treatment of subfertile patients. The risk of scar rupture is very high during the third trimester. The rate of total uterine rupture has been reported about 0.07%.
| Case|| |
A 33-year-old woman, Mrs. KS, a homemaker by occupation, with an obstetric score of P1L0, was anxious to conceive for 2 years. She gave a history of undergoing laparoscopic myomectomy in 2013 following which she conceived spontaneously in 2015. However she underwent emergency subtotal hysterectomy at 32 weeks for uterine rupture. Ovaries were preserved at the time of surgery. She was evaluated and enrolled in the surrogacy program in 2017, following the guidelines stated in the surrogacy bill.
- 1. Ultrasound by transvaginal sonography
Uterus is not imaged as per her old surgical history: Right ovary: 3.4 × 2.4 × 2.5 cm; volume: 10.2 cc; antral follicular count (AFC): 4
Left ovary: 3.8 × 2.7 × 2.5 cm; volume: 13.3 cc; AFC: 5
- 2. Serum AMH: 3.25 ng/mL
Assisted reproductive technology-intracytoplasmic sperm injection (ICSI) (self gametes) was planned. She was stimulated with gonadotropins, Gonal F, and human menopausal gonadotropins in antagonist protocol. Follicular study was done and monitored. When the follicles reached >20 mm, recombinant hCG trigger was given. Ovum pick up was done within 35 h of trigger, and three oocytes collected. ICSI was done with all three mature (MII) oocytes; two day 3 embryos were vitrified.
She was started on hormone replacement treatment-frozen embryo transfer protocol, and two day 3 embryos were transferred to a surrogate mother. Pregnancy was confirmed with serum beta hcg 15 days later. Clinical pregnancy was confirmed at 6 weeks. Antenatal checkups were regularly followed up, and all trimesters were uneventful. She delivered a term healthy baby in 2017.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kumari R Surrogate Motherhood—Ethical or Commercial. Centre for Social Research; 2017. p. 175. Available from: https://wcd.nic.in/sites/default/files/final%20report.pdf
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Gardeil F, Daly S, Turner MJ Uterine rupture in pregnancy reviewed. Eur J Obstet Gynecol Reprod Biol 1994;56:107-10.