The frequency and management of uterine perforations during first-trimester abortions

Abstract

The frequency and management of uterine perforation during first-trimester abortions remain a matter of continuing debate among gynecologists. The rate of uterine perforations was 1.3/1000 procedures (eight cases) in 6408 women undergoing first-trimester abortions at our clinic. We also performed 706 first-trimester abortions at the time of laparoscopic sterilization. Two perforations (2.8/1000 procedures) were reported before laparoscopy. Twelve (15.6/1000 procedures) unsuspected perforations were discovered during direct laparoscopic visualization. This represents a 19.8/1000 procedure rate of perforation (14 cases). All 22 patients with perforations were managed conservatively, and no immediate or late complications were noted. Our data suggest that the true incidence of uterine perforations is significantly underestimated and serious complications caused by perforations are rare. Conservative therapy is recommended rather than early surgical intervention.

PIP: The incidence of uterine perforation during 1st-trimester abortion has been estimated at 0.8-6.4/1000 procedures; however, in studies where direct pelvic visualization has been used, this rate has been as high as 30/1000. To obtain more information on the incidence of recognized and unsuspected uterine perforations and their management, all 1st-trimester abortions performed at a New York outpatient clinic in 1986 and 1987 were prospectively studied. There were 8 cases of uterine perforation among the 6408 abortion patients during the study period, for a rate of 1.3/1000 procedures. 6 of the 8 perforations were sustained under general anesthesia. An additional 706 1st-trimester abortions were combined with laparoscopic sterilization. In this group, 2 perforations were reported before direct visualization and an additional 12 were recognized only through the laparoscope. 9 of the perforations occurred in the fundus. The 19.8/1000 procedures uterine perforation rate obtained in the laparoscopic group is 7 times higher (p0.001) than that recognized with traditional methods, suggesting that most perforations escape medical detection. All 22 perforation patients in this series required no treatment and reported no complications. Unless intra abdominal contents have been brought through the cervix, a conservative approach to managing recognizing perforations is sufficient.