We often are asked to review tubal ligation operative notes in which uterine windows were seen at the time of c-section. Often the patient’s doctor recommended a tubal ligation because a uterine window was observed and the doctor believed the risk of uterine rupture in future pregnancy would be higher.
Often patients feel pressured into having an unanticipated tubal ligation because of a newly diagnosed condition. Over time these women regret their decision about having a tubal ligation and often feel they were ‘sold’ a tubal ligation.
They eventually contact our office asking if they are candidates for tubal reversal surgery and will the uterine window cause any future problems to pregnancy?
What is a uterine window?
Simply explained a uterine window is a weakness in the uterine muscle. A uterine window can happen in any woman who has had uterine surgery but the most common reason is a previous c-section. Uterine windows are often discovered in the third trimester at the time of c-section.
When a uterine window occurs the uterine wall becomes as thin as Saran Wrap and the baby can clearly be seen through the thin uterine muscle. Hence the term ‘uterine window’. It is commonly believed uterine windows will eventually progress to rupture of the uterus if enough time and stress are allowed.
Many doctors believe the risk of uterine rupture is increased in future pregnancies when a uterine window is discovered and will often encourage women to have a tubal ligation to prevent the possible risk of future rupture.
It is because of this belief that many women are counseled to have a tubal ligation.
Feeling the heat: Tubal reversals in patients with uterine windows
I was recently contacted by the doctor of a recent reversal patient. The doctor, very politely, asked me if I had read the patient’s c-section operative note and if I had noted the diagnosis of a uterine window. I responded that I was aware of the diagnosis.
The doctor then proceeded, very politely, to ask me why I performed a tubal reversal on her patient and if I counseled the patient about the future risks of pregnancy because of the uterine window. I responded that I did but that it is our practice to let our patients decide what is best for their reproductive needs.
I then explained in my previous OB practice I had performed many c-sections and diagnosed uterine windows. I then went on to explain I had performed repeat c-sections on many of these women and most of them had normal findings and no uterine windows. I explained to this doctor we may mistakenly believe a uterine window is bad but my personal experience did not support this belief and furthermore there is no medical literature suggesting these beliefs are true.
The conversation ended rather abruptly and I could sense she was upset and did not agree with me.
Research about uterine windows
A study about uterine windows was recently published in the Journal of Obstetrics and Gynecology. The authors studied 30 women with prior uterine dehiscence (uterine windows) and 14 women who had prior uterine rupture (torn uterine muscle). They recommended early, repeat c-section ( 1 to 4 weeks before their due dates) in these patients and no major complication occurred. Furthermore in these 44 women only 6% of these patients had asymptomatic uterine windows at the time of repeat c-section.
The conclusion of the study was women with prior uterine rupture or uterine windows can have excellent outcomes in future pregnancy if they are followed closely and have early delivery by repeat c-section.
This study made me feel better about my advice to patients and my personal experience in obstetrics.
Uterine window and uterine rupture: Is tubal reversal possible?
If you have been diagnosed with a uterine window and want a tubal reversal you can be reassured that if you are followed closely during future pregnancy and have early delivery by c-section then you have a good chance at having an excellent outcome.
For more information about tubal reversal surgery call (919) 977-5050 or visit our website: Tubal Reversal With A Personal Choice
Pregnancy Outcomes in Patients With Prior Uterine Rupture or Dehiscence. Fox, Nathan S. MD; Gerber, Rachel S. MD; Mourad, Mirella MD; Saltzman, Daniel H. MD; Klauser, Chad K. MD; Gupta, Simi MD; Rebarber, Andrei MD. Obstet Gynecol 2014; 123:785-9.