Uterine perforation following abortion in Tikur Anbessa Hospital, Addis Ababa, Ethiopia: A case series study

Abstract

AbstractObjective: determine incidence, describe patient characteristics, examine clinicalpresentation, associated complications and describe mode of management of cases withuterine perforation.Methods: Operation registry, abortion care logbook and patients’ clinical records werereviewed in a teaching hospital in Addis Ababa, Ethiopia, between January 1, 1999 andDecember 31, 2000. Cases with laparatomy proven uterine perforation are described.Setting: obstetric and gynecologic department of a tertiary referral and teaching hospitalin Addis Ababa, Ethiopia.Outcome measures: clinical presentation, intraoperative findings, site of perforation,mode of management, associated complications and outcome of treatment.Results: there were a total of 927 abortions of which 25 were laparatomy proven cases ofuterine perforation following unsafe abortion, making the prevalence 27/1000 abortions.Majority were fond to be single, nulliparous, young and dependent member of the family.In 36% (9/25) termination was attempted after 14 weeks of gestation. Plastic and metallicmaterials are used frequently. Eight of the cases came after seven days of interference.The main clinical presentations were: abdominal pain (100%), signs of peritonitis(100%), pallor (96%), fever (76%) and vaginal bleeding (76%). Common intraoperativefindings include abdominal abscess, adhesions, and inflamed ovaries and tubes. Frequentareas of perforation are posterior aspect of the body and cervico-isthmic region of theuterus. Drainage and lavage of the abdominal cavity (80%), hysterectomy (76%) andremoval of adnexa (60%) were mainstays of management. All cases had sepsis andperitonitis, 24 had anemia, nine suffered from adult respiratory distress syndrome andeight developed wound infection. Duration of hospital stay ranged from one to 45 days.The case fatality rate was 32% (8/25). Only six came back for follow up.Conclusion: Uterine perforation is associated with increasing number of complicationsincluding death. Physicians catering the health care of women with unsafe abortion shallexhibit a high index of suspicion for uterine perforation. (Ethiop. J. Repro Health May2007, 1(1):17-27)