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  • Title: [Necrotic uterine myomatosis--a rare complication following vaginal termination of pregnancy by suction (author's transl)].
    Author: Gubisch W, Sonnenburg G.
    Journal: Zentralbl Gynakol; 1981; 103(8):456-9. PubMed ID: 7269882.
    Abstract:
    Reported in this paper is the case history of a patient with necrotised uterine myomatoma, a rare complication following vaginal termination of pregnancy. Course and therapy are described and the problem discussed. Total postoperative complications after induced abortion in the German Democratic Republic is 9.7%. This increases to 20% in women over 35 years old with a uterine myoma and concurrent pregnancy. Necrotic degeneration of a myoma following induced abortion is rare in the literature. A 43 year old patient presented for therapeutic abortion at 3 months pregnancy. A uterine myoma of the posterior wall was found at preoperative evaluation. Vaginal suction evacuation was performed under anesthesia. After subsiding of symptoms further gynecological palpation showed a fist-size, painful, retroflexed uterus with painful adnexa and Douglas' pouch. Antibiotics were used to treat the adnexitis. Diminishing of symptoms did not result in decrease of uterine size and laparotomy was done for suspected degenerative softening of the myoma. Partially necrotized uterine myoma, solidly encased in the Douglas' pouch, was found and radical hysterectomy was performed. Except for a successfully treated urinary infection the postoperative course was smooth and patient was discharged on day 17. Histology findings were nonmalignant, fibrosed intramural leiomyoma of the uterus. Degenerative changes of uterine myomas are most likely caused by nutritional deficiency of the myoma. Space restriction following therapeutic abortion, risk of possible tissue trauma, thrombus formation and bacterial infection can all induce the necrotic process. Necrosis of uterine myomas should be considered as a possible complication in a typical postoperative course of therapeutic abortion.
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