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Uterine Window and Uterine Rupture: Is Tubal Ligation Necessary?

PTLS-specialistWe 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?

tubal-reversal-surgeonIf you have had a uterine window or uterine rupture then future pregnancies are considered to be higher risk but tubal ligation is not necessarily required.

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

Reference

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.

 

Need More Information About Tubal Reversal?

A Personal Choice Tubal Reversal Center is in Raleigh, North Carolina and specializes in tubal ligation, Essure, and vasectomy reversal surgery.

Dr. Monteith specializes in helping couples have more beautiful children with reversal surgery and helping women treat abnormal symptoms after their tubes have been tied!

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By joining the group you can communicate with other women who have had successfully reversed their tubal ligation and restored their natural fertility.

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5 Comments

Lena Solomon Reply

During my 2nd c section delivery the doctors found a large uterine window Which was repaired and the delivery was normal.. After 4 years I had an ultrasound done and they found an isthmocele on the scar. My doctor told me it’s riscky to get pregnant and the percentages of the risks are not available. Now I’m afraid to get pregnant but I really want another baby. From your experience have you ever come across patients like me who had a large uterine window in combination with an isthmocele who had a normal delivery without uterine ruptures?


    Dr. Monteith Reply

    When the uterus heals it will make it self stronger. Just because you had a window the last pregnancy does not mean you will have one the next pregnancy. Most pregnancies will do fine. To be honest, I am not sure what an isthmocele is….never heard of that term before.

    We have had many patients come to us for reversal after they had a tubal ligation they regretted because of a uterine window and fear of future pregnancy.

    We should be able to help you. We can reverse most tubal ligation procedures.

    The first step to see if you are a candidate is to send us your tubal ligation reports to us for a free review and we can let you know if you are a candidate for reversal surgery.

    Your reports can be obtained from the medical records department where your tubal ligation surgery was performed.

    We charge $6,900 total plus $150 to schedule and we are located in Raleigh, North Carolina.

    Patients pay in full and out-of-pocket at the time of scheduling. All you have to pay for in addition to the surgical fee is the cost of travel, hotel, and food.

    On average the chance of pregnancy after tubal ligation reversal is about 60% if you are under age 42.

    We do have a prepayment tubal reversal plan that allows you to save towards your reversal over a 3 year period.

    Although $6,900 seems expensive…the alternative treatment in-vitro fertilization (IVF) average $12,000 to $14,000 and is about 40% successful!

    The main advantage to tubal reversal is that every month you have a chance and you can become pregnant more than once.

    The following link will answer most of your questions about reversal. This is the MOST HELPFUL INFORMATION to read when considering reversal at our office. Each question has a link to more information about the question:

    Frequently asked questions about tubal reversal

    Call us at (919) 977-5050 8am to 5pm eastern standard time and we would be happy to speak with you about tubal reversal at our facility.


Laura Reply

I’m 40 years old now back in 2011 I was told to have a tubial litigation done due to thin uterial lining from c-sections. My Husband and I wanted more kids,but was scared I would die if I had another baby. We’ve been thinking about getting a reversal done because in 2012 I was told I had cyst on my right ovary and I’ve had nothing but problems ever since I got my tubial done. Is there anything I can do? I don’t have insurance right now, but are discussing about paying out of pocket.


    Dr. Monteith Reply

    Laura
    Your best chances for pregnancy will be the next two years….dont delay you’re decision to try and become pregnant for too long.

    We should be able to help you. We can reverse most tubal ligation procedures.

    The first step to see if you are a candidate is to send us your tubal ligation reports to us for a free review and we can let you know if you are a candidate for reversal surgery.

    Your reports can be obtained from the medical records department where your tubal ligation surgery was performed.

    We charge $6,900 total plus $150 to schedule and we are located in Raleigh, North Carolina.

    Patients pay in full and out-of-pocket at the time of scheduling. All you have to pay for in addition to the surgical fee is the cost of travel, hotel, and food.

    On average the chance of pregnancy after tubal ligation reversal is about 60% if you are under age 42.

    We do have a prepayment tubal reversal plan that allows you to save towards your reversal over a 3 year period.

    Although $6,900 seems expensive…the alternative treatment in-vitro fertilization (IVF) average $12,000 to $14,000 and is about 40% successful!

    The main advantage to tubal reversal is that every month you have a chance and you can become pregnant more than once.

    The following link will answer most of your questions about reversal. This is the MOST HELPFUL INFORMATION to read when considering reversal at our office. Each question has a link to more information about the question:

    Frequently asked questions about tubal reversal

    Call us at (919) 977-5050 8am to 5pm eastern standard time and we would be happy to speak with you about tubal reversal at our facility.


Megan Reply

I’m so grateful I came across this site. I had my 3rd csection June of 2017. My husband and i want more, my doctor did not perform a tubal but the nurse who took me to my room said he found a window and will talk to you about it at your follow up appointment. He never mentioned it. I keep wondering why he never said anything of it’s a dangerous as people say. Thank you for any input. I plan to see him in April and discuss my operative notes with him.

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