Geburtshilfe Frauenheilkd 2014; 74 - PO_Endo04_18
DOI: 10.1055/s-0034-1388024

Chromolaparoscopy, hysteroscopy, myomectomy and hysterotomy during the early implantation phase of an undetected pregnancy: Delivery of a child with a complex brain malformation

C Mann 1, K Karl 2, R Kästner 1, S Hutter 1, H Weigand 3, C Thaler 4
  • 1Klinikum der Universität München, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe Innenstadt, München, Germany
  • 2Praxis für pränatale Diagnostik, München, Germany
  • 3Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Entwicklungsneurologie, München, Germany
  • 4Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe- Großhadern, Gynäkologische Endokrinologie, München, Germany

Case report: A Chromolaparoscopy, hysteroscopy and myomectomy was performed in a 38-year-old patient, who presented with secondary sterility and uterine fibroids. The uterine cavity was opened, while removing two fibroids. Chromopertubation showed closed fallopian tubes.

Four weeks later the patient presented with an intact intrauterine pregnancy. Retrospectively the gestational age at the day of this operation was around 2+6. This is consistent with a negative HCG serum concentration that was documented five days prior to this date. Upon thorough evaluation, no hint for potential teratologic effects of the operation and related compounds was revealed. The couple clearly decided to continue the pregnancy.

Following ultrasound examinations showed an enlarged cisterna magna and a mild ventriculomegaly as well as a hypoplasia of the cerebellar vermis. Site and morphology of the placental implantation appeared to be normal.

An elective cesarean section was performed in the 37th gestational week, because of progressive thinning of the uterine myomectomy scar. A female infant of normal weight and size was delivered. A MRI demonstrated a complex brain malformation with a congenital hypoplasia of Vermis and Cerebellum, a moderate microcephaly and multiple heterotopias. The developmental neurologic examination at three months showed a central movement disorder.

Conclusion: The pregnancy in the early implantation phase was not disrupted by the invasive procedure. This is consistent with stable adhaesions between blastocyst and early decidua that are established even before embryonic penetration. We did not identify any potential connection between the operation and the complex brain malformation identified in the newborn.