A Bolt from the Blue for an Obstetrician: A Case Series of Life Threatening Surgical Emergencies following Evacuation of Unwanted Pregnancy QR01-QR03
Dr. Kusum Dogra,
Department of Obstetrics and Gynaecology, UCMS and GTB Hospital, Delhi-110095, India.
Unwanted pregnancies are those that are mistimed, unplanned or unwanted at the time of conception and mostly end up in induced abortion. Dilation and Curettage (D&C) is a procedure which involves dilatation of the cervix and introduction of a thin instrument to remove tissue from the inside of the uterus. D&C is associated with quite a few complications, one being perforation of the uterus which isn’t an uncommon accident during D&C. Uterine perforation consequent intestinal perforations and bowel prolapse not only occur with inexperienced and untrained persons but also amongst experienced doctors in certain cases. The most frequent surgical management of uterine perforation with bowel injury is repair of the uterine wall along with resection and anastomoses of the injured bowel. In present series, three cases of abortions performed by cervical D&C in a tertiary care hospital in Delhi, India in February and March 2021, of which two resulted in uterine perforation and bowel prolapse through the vagina, and one was a suspected perforation. Both patients with bowel prolapse were rigorously resuscitated and taken up for an emergency laparotomy. Though complications such as perforation and bowel injury are inevitable, further morbidity to the patients can be alleviated if handled with expedient identification and intervention.