Pregnancy After a Laparoscopic Sacrohysteropexy: a Case Report

Abstract

Pelvic Organ Prolapse (POP) is a rare condition during pregnancy. If all conservative treatments fail, the surgical approach has proven to be in non-pregnant women a very good option due to high efficacy and a very low morbidity and mortality rate. We are reporting on the clinical results of a 33-year-old pregnant woman with a past history of laparoscopic sacrohysteropexy who delivered by caesarean section due to a foetal breech presentation. There are only a handful of cases reporting the outcome “pregnancy” after a laparoscopic sacrohysteropexy. Nevertheless, this appears to be a useful intervention for women with a POP unresponsive to conservative treatment and open family planning. Further studies with long-term follow-ups are required to confirm this.

Zusammenfassung

Descensus genitalis (Pelvic Organ Prolapse; POP) ist ein seltenes Leiden in der Schwangerschaft. Wenn alle konservativen Therapien erfolglos sind, hat sich, aufgrund einer hohen therapeutischen Wirksamkeit und einer niedrigen Morbiditäts- bzw. Mortalitätsrate, ein chirurgisches Vorgehen bei nicht graviden Frauen als eine gute therapeutische Option herausgestellt. Wir beschreiben den klinischen Verlauf einer 33-jährigen Patientin, die nach einer laparoskopischen Sakrohysteropexie schwanger wurde und, aufgrund fetaler Beckenendlage, per Kaiserschnitt entbunden wurde. Nur wenige Fallbeispiele beschreiben das Outcome „Schwangerschaft“ nach laparoskopischer Sakrohysteropexie. Trotzdem erscheint dies ein sinnvoller Eingriff bei konservativ-therapierefraktärem POP und nicht abgeschlossener Familienplanung zu sein. Weitergehende Studien mit Langzeit-Follow-up werden hierfür zur Überprüfung benötigt.

Key words

sacrohysteropexy - pelvic organ prolapse - pregnancy - delivery

Schlüsselwörter

Sacrohysteropexie - Prolaps - Schwangerschaft - Entbindung

• References

• 1 Patel PD, Amrute KV, Badlani GH. Pelvic organ prolapse and stress urinary incontinence: a review of etiological factors. Indian J Urol 2007; 23: 135-141
• 2 Hendrix SL, Clark A, Nygaard I et al. Pelvic organ prolapse in the Womenʼs Health Initiative: gravity and gravidity. Am J Obstet Gynecol 2002; 186: 1160-1166
• 3 Naumann G, Kölbl H. Current developments and perspectives on the diagnosis and treatment of urinary incontinence and genital prolapse in women. Geburtsh Frauenheilk 2012; 72: 202-210
• 4 Khunda A, Vashisht A, Cutner A. New procedures for uterine prolapse. Best Pract Res Clin Obstet Gynaecol 2013; 27: 363-379
• 5 Graefe F, Marschke J, Dimpfl T et al. Vaginal vault suspension at hysterectomy for prolapse – myths and facts, anatomical requirements, fixation techniques, documentation and cost accounting. Geburtsh Frauenheilk 2012; 72: 1099-1106
• 6 Tsikouras P, Dafopoulos A, Vrachnis N et al. Uterine prolapse in pregnancy: risk factors, complications and management. J Matern Fetal Neonatal Med 2014; 27: 297-302
• 7 Mohamed-Suphan N, Ng RK. Uterine prolapse complicating pregnancy and labor: a case report and literature review. Int Urogynecol J 2012; 23: 647-650
• 8 Johnson JA, Tough S. Delayed child-bearing. J Obstet Gynaecol Can 2012; 34: 80-93
• 9 Zucchi A, Lazzeri M, Porena M et al. Uterus preservation in pelvic organ prolapse surgery. Nat Rev Urol 2010; 7: 626-633
• 10 Barranger E, Fritel X, Pigne A. Abdominal sacrohysteropexy in young women with uterovaginal prolapse: Long-term follow-up. Am J Obstet Gynecol 2003; 189: 1245-1250
• 11 Lewis CM, Culligan P. Sacrohysteropexy followed by successful pregnancy and eventual reoperation for prolapse. Int Urogynecol J 2012; 23: 957-959
• 12 Busby G, Broome J. Successful pregnancy outcome following laparoscopic sacrohysteropexy for second degree uterine prolapse. Gynecol Surg 2010; 7: 271-273
• 13 Hefni M, El-Toukhy T. Sacrospinous cervico-colpopexy with follow-up 2 years after successful pregnancy. Eur J Obstet Gynecol Reprod Biol 2002; 103: 188-190