Uterine rupture in pregnancy following interstitial salpingectomy: case series and review of the literature

Abstract Background Spontaneous uterine rupture in individuals without a prior uterine surgical history is a rare but catastrophic obstetric emergency. Previous studies have proposed an association between previous salpingectomy and subsequent uterine rupture; however, most published cases were complicated by concurrent risk factors, including previous cesarean delivery, abnormal placental implantation, and pathological pregnancy, which precluded the confirmation of an independent causal association. By analyzing a series of gestational uterine rupture cases occurring in patients with isolated interstitial salpingectomy and no pre-existing uterine cornual lesions or prior uterine surgery, combined with a review of the relevant literature, this study aims to highlight a potentially distinct pathogenic mechanism underlying this uncommon obstetric complication. Case presentation This report describes five cases of gestational uterine rupture following interstitial salpingectomy. Among them, two patients received prophylactic salpingectomy before assisted reproductive treatment, while three underwent salpingectomy due to ectopic pregnancy. The interval between salpingectomy and subsequent pregnancy ranged from 1 month to nearly 6 years. Most cases (four/five) presented with atypical or asymptomatic uterine rupture, while only one patient showed obvious clinical symptoms. This symptomatic patient had a history of induced abortion and abnormal placental implantation. Fetal demise occurred in two cases, including one involving a twin gestation. No maternal fatalities were reported. Conclusion Gestational uterine rupture is a rare but serious complication following interstitial salpingectomy. It frequently occurs in the middle and late trimesters and is commonly asymptomatic, which increases the difficulty of early clinical recognition. Prenatal ultrasound contributes to timely diagnosis. The present findings suggest that uterine cornual damage caused by radical or thermal-injured interstitial salpingectomy may be closely associated with subsequent gestational uterine rupture.