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Published:
Apr 29, 2022DOI:
10.4314/ahs.v22i1.23Keywords:
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Main Article Content
Multiple uterine perforations during manual vacuum aspiration: the need to increase the clinical awareness of attending healthcare professionals
Abstract
Background: The risk of uterine perforation during manual vacuum aspiration (MVA) is reduced by using Karman cannula (which has a rounded tip) during the procedure.
Methods: A 35-year-old multigravida at 13 gestational weeks presented with vaginal bleeding of a day duration and ultrasound evidence of retained products of conception suggestive of incomplete miscarriage. The patient was rhesus D positive and stable. She had MVA which was performed using Karman cannula, and developed severe vaginal bleeding. The differential diagnoses were incomplete uterine evacuation and uterine perforation.
Results: During a laparotomy in Lloyd-Davies position, haemoperitoneum and six uterine perforations on the anterior and fundal parts, each approximately 5 mm in length (Figure 1), were found. The perforations were repaired and a check uterine curettage under oxytocic cover showed an empty uterus. The abdominal cavity was washed and closed. She was transfused three units of red blood cell concentrate and had a normal six weeks follow-up.
Conclusion: When an instrument inserted into the uterus is pushed beyond the estimated depth of the uterus, a perforation must be suspected and the condition may be managed conservatively. A surgical procedure complicated by surgeon’s loss of perception (in this case tactile) of tissues’ anatomy is hazardous.
Keywords: Image of uterine perforation; manual vacuum aspiration; uterine sounding.
