SONOGRAPHIC DETECTION OF UTERINE PERFORATION IN SURGICAL ABORTIONS: CASE REPORT FROM A DEVELOPING COUNTRY.

Main Article Content

Yaw Amo Wiafe Ijeoma Anyitey-Kokor Benedict Apaw Agyei Adu Appiah-Kubi Gerald Owusu-Asubonteng

Abstract

Uterine perforation is a rare major complication of surgical abortion which can be detected by ultrasound. In the last four decades, over 70% of case reports on uterine perforation in surgical abortions were from developing countries. Yet ultrasound was rarely used in detecting uterine perforation. This case report presents two cases of uterine perforation in surgical abortions which were detected by ultrasound prior to laparotomy. In the first case, a 34-year old woman was referred to our facility as a case of hypovolaemic shock following termination of pregnancy. An ultrasound examination performed to exclude an intra-abdominal abscess collection revealed a 1.2cm defect in the fundal region of the uterus with extrusion of abdominal contents into the endometrial cavity through the defect. In the second case, a 31-year old woman presented with a history of vomiting, abdominal pain, abdominal distension and absolute constipation after undergoing an evacuation of the uterus for a spontaneous abortion at 7 weeks’ gestation. Transabdominal ultrasound showed a defect of 1.4cm wide at the fundus of the uterus, with a structure extending from the abdominal cavity through the defect and into the endometrial cavity. It also showed distension of multiple bowel loops within the abdominal cavity. Sonographic detection of uterine perforation led to appropriate management in both cases. In developing countries, where the incidence of major complications of abortion is still very high, utilizing ultrasound can be helpful in detecting complications such as uterine perforation.

Article Details

How to Cite
WIAFE, Yaw Amo et al. SONOGRAPHIC DETECTION OF UTERINE PERFORATION IN SURGICAL ABORTIONS: CASE REPORT FROM A DEVELOPING COUNTRY.. Medical Research Archives, [S.l.], v. 7, n. 6, june 2019. ISSN 2375-1924. Available at: <https://journals.ke-i.org/index.php/mra/article/view/1944>. Date accessed: 22 july 2019. doi: https://doi.org/10.18103/mra.v7i6.1944.
Section
Case Reports

References

1. Pridmore BR, Chambers DG. Uterine perforation during surgical abortion: a review of diagnosis, management and prevention. Aust N Z J Obstet Gynaecol 1999; 39:349–353
2. Grossman D, Blanchard K, Blumenthal P. Complications after second trimester surgical and medical abortion. Reprod Health Matters 2008; 16:173–182
3. Obed SA, Wilson JB. Uterine perforation from induced abortion at Korle Bu Teaching Hospital, Accra, Ghana: a five year review. West Afr J Med 1999; 18:286–289
4. Diedrich J, Steinauer J. Complications of surgical abortion. Clin Obstet Gynecol 2009; 52:205–212
5. Singh S, Maddow-Zimet I. Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries. Obstet Gynaecol 2016; 123:1489–1498
6. Augustin, G., Majerović, M., & Luetić, T. Uterine perforation as a complication of surgical abortion causing small bowel obstruction: a review. Arch Gynecol Obstet 2013; 288: 311-323.
7. Chauhan, N. S., Gupta, A., Soni, P. K., Surya, M., & Mahajan, S. R. Iatrogenic uterine perforation with abdominal extrusion of fetal parts: A rare radiological diagnosis. J Radiol Case Rep 2013; 7:41-47.
8. Sajadi-Ernazarova KR, Martinez CL. Abortion Complications. StatPearls Publishing 2019. https://www.ncbi.nlm.nih.gov/books/NBK430793/ (PMID: 28613544).
9. O'Connell, K., Jones, H. E., Simon, M., Saporta, V., Paul, M., & Lichtenberg, E. S. First-trimester surgical abortion practices: a survey of National Abortion Federation members. Contraception 2009; 79: 385-392.
10. Darney PD, Sweet RL. Routine intraoperative ultrasound for second trimester abortion reduces incidence of uterine perforation. J Ultrasound Med 1989; 8: 71–75.
11. Acharya, G., Morgan, H., Paramanantham, L., & Fernando, R. A randomized controlled trial comparing surgical termination of pregnancy with and without continuous ultrasound guidance. Eur J Obstet Gynecol Reprod Biol 2004; 114: 69-74.
12. Abdulkareem, A. F., Abdelazim, I. A., Abu-Faza, M., Abdelrazek, K. M., & Farghali, M. M. Ultrasound-guided surgical suction evacuation (US-SSE) for missed miscarriage. J Obstet Gynecol Investig 2018; 1: 1-5.
13. Vlassoff M Shearer J Walker D Lucas H Economic impact of unsafe abortion-related morbidity and mortality: evidence and estimation challenges. Brighton, UK: Institute of Development Studies 2008. https://www.ids.ac.uk/files/dmfile/RR59.pdf
14. Singh S, Darroch JE and Ashford LS, Adding It Up: The Costs and Benefits of Investing in Sexual and Reproductive Health 2014, New York: Guttmacher Institute. https://www.guttmacher.org/report/abortion-worldwide-2017

Most read articles by the same author(s)

Obs.: This plugin requires at least one statistics/report plugin to be enabled. If your statistics plugins provide more than one metric then please also select a main metric on the admin's site settings page and/or on the journal manager's settings pages.