Uterine perforation following medical termination of pregnancy by vacuum aspiration

Abstract

Out of 9344 first trimester elective abortions performed by vacuum aspiration, 37 uterine perforation cases occurred. The suction cannula was responsible for more than 50% of perforations. All cases were multiparous. In 56.8%, the duration of gestation was 6 weeks or less. One third of the cases had a history of child birth within the previous 6 months. Fundal and anterior wall perforations were most common. Cases with a retroverted uterus had a higher incidence of perforation (59.4%) than those with an anteverted uterus (32.4%). Exact pelvic assessment and proper technique and case management are important for preventing perforation.

PIP: This study analyzed the 37 cases of uterine perforation that occurred in a series of 9344 1st-trimester vacuum aspiration abortions performed at a hospital in New Delhi, in 1972-81. The overall incidence of perforation was 0.4%. All the uterine perforation cases were multiparous, and 21.6% had more than 4 children. 32.4% of cases had delivered their last child within 6 months of the abortion procedure. The perforation rate was higher when a womsn was lactating. Fundal or cornual and anterior wall perforations were most common; in 59.4% of these cases, the uterus was retroverted. The suction cannula was responsible for 51.3% of the perforations; the dilator was the instrument responsible in 24.3% and the curette in 16.2%. Most perforations were suspected at the end of suction evacuation (43.2%) or at the time of check curettae (21.6%). Surgical repair was carried out in 83.7% fo cases, and combined with tubal sterilization in 70.2% of cases. Associated bowel injury was present in 3 (8.1%) cases. The policy recommended for cases of suspected perforation is to perform a diagnostic laparoscopy and plan further case management on the basis of the site and size of perforation, the extent of damage, the amount of bleeding, completeness of the procedure, and the parity of the patient. When the sucttion cannula is the instrument responsible, the bowel should be explored for possible injury. Occasionally hysterectomy may be required for severe damage or excessive bleeding.