Posterior Uterine Rupture during Pregnancy in a Patient with Previous Surgery for Severe Endometriosis: A Case Report

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BSTRACT

Deep infiltrating endometriosis (DIE) is a severe pathology requiring complex pelvic surgery, which carries a rare but serious risk of uterine rupture during pregnancy. We report a primiparous patient who achieved pregnancy through in vitro fertilisation 11 months after laparoscopic resection of a rectovaginal DIE nodule. At 32 + 3 weeks of gestation, altered foetal rhythm and maternal anaemia led to an emergency caesarean section, revealing a rupture of the posterior uterine wall. The post-partum period was uneventful despite significant psychological stress. This case highlights retrocervical surgery and monopolar energy use as potential risk factors for uterine rupture. It underlines the importance of a morphological assessment of the posterior uterine segment, personalised preconception and prenatal care and thorough patient counselling regarding potential obstetric risks in patients undergoing surgery for DIE, especially in the absence of specific international recommendations.