Abstract
Uterine perforation is an uncommon yet serious complication of surgical management of first and second trimester termination of pregnancies. The rate of uterine perforation is under reported, as patients are usually asymptomatic. Although uncommon, uterine perforation can cause life-threatening complications for some patients. This case report discusses a second trimester surgical termination resulting in uterine perforation and haemorrhage secondary to an avulsion of the infundibulopelvic ligament and prolapse of the left fallopian tube and ovary into the uterine cavity. A literature search was undertaken to compare this case report to those previously published. To the best of our knowledge, this is the first case report in Australia that discusses a unique case of a severed infundibulo-pelvic ligament as a cause for trans-vaginal uterine bleeding post second trimester termination of pregnancy.
Highlights
IntroductionSurgical intervention (dilatation and curettage) for first and second trimester termination of pregnancy is quite common
Surgical intervention for first and second trimester termination of pregnancy is quite common
The centre for disease control in the United States estimated that in 2008 the pregnancy termination rate was 16 per 1000 women between 15-44 years of age [2] and second trimester termination rate was less than 1 percent [3, 4]
Summary
Surgical intervention (dilatation and curettage) for first and second trimester termination of pregnancy is quite common. Uterine perforation is an uncommon, yet serious complication of surgical termination of pregnancy [1]. The common symptoms reported in cases where fallopian tube herniation occurred in the uterine cavity are abdominal or pelvic pain, offensive vaginal discharge, mild vaginal bleeding, secondary infertility post surgical termination and abdominal distension [1, 3, 5, 6, 10-13]. Further inspection of the upper pelvis showed an avulsed left infundibulo-pelvic (IP) ligament as the cause of the bleeding in the pelvis, which was surprisingly minimal It appeared that during the TOP, the instrument used to perform the procedure had perforated the left lateral uterine wall, missed both the uterine artery and ureter, grasped the left ovary and avulsed the left infundibulo-pelvic ligament. The complication was discussed with the clinic and the doctor who performed the procedure
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