Laparoscopic Sacrohysteropexy in a Woman at 12 Weeks' Gestation.

STUDY

OBJECTIVE

To demonstrate laparoscopic sacrohysteropexy for a case of uterine prolapse in a 12 weeks, 3 days pregnant woman. To our knowledge this is the first case of laparoscopic sacrohysteropexy performed at 12 weeks of gestation to be reported in literature.

DESIGN

A step-by-step explanation of the surgical procedure (Canadian Task Force classification III).

SETTING

Maltepe University Hospital.

PATIENT: A 37-year-old pregnant woman.

INTERVENTION: Laparoscopic sacrohysteropexy. Institutional Review Board ruled that approval was not required for this study.

MEASUREMENTS AND MAIN

RESULTS

Uterine prolapse is very rare condition, manifesting in an estimated 10 000 to 15 000 pregnancies [1]. The management plan must be individualized, and the obstetrician should aware of possible complications, such as preterm labor, high incidence of abortion, cervical ulceration, and cervical dystocia. In general, bedrest, good genital hygiene, and pessary use is recommended. Alternatively, in cases where conservative solutions have failed, laparoscopic surgery in the pregnant patient may be considered. To date, only 1 case of laparoscopic promontohysteropexy at 10th weeks of gestation was reported by Pirtea et al [2]. A 37-year-old woman, at 12 weeks and 3 days of gestation, with stage III pelvic organ prolapse was referred to our clinic. Conservative management with pessary failed. The patient underwent laparoscopic sacrohysteropexy after written informed consent form was obtained. In exploration, uterine manipulation was difficult because of softness and large size of the uterus. First, the sigmoid colon was suspended at the abdominal wall to gain an adequate surgical field. The promontorium was dissected and the parietal peritoneum incised on the right pelvic side wall after ureter visualization. A polypropylene mesh was fixed to the cervix at the level of the uterosacral ligaments. The other edge of the mesh was fixed at the level of the promontory using the Uplift device (Neomedic International, Barcelona, Spain). Then, the peritoneum was sutured to cover the mesh. The patient was discharged 2 days after surgery. At the examination the pelvic floor was detected to be normal. The patient delivered a healthy baby weighing 3030 g by cesarean section at 38 weeks of gestation. The position of the mesh was controlled during surgery. There was no peritoneal fold detected on the cervical part of mesh; however, no adhesion was observed.

CONCLUSION

Laparoscopic sacrohysteropexy may be an alternative and safe approach, if conservative treatment fails, for pelvic organ prolapse during pregnancy.