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.