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  • Title: Management of uterine perforation following elective abortion.
    Author: Freiman SM, Wulff GJ.
    Journal: Obstet Gynecol; 1977 Dec; 50(6):647-50. PubMed ID: 927753.
    Abstract:
    Experience is reported with 28 uterine perforations encountered from June 1, 1973, to June 1, 1976, among 20,000 first trimester abortion patients at Reproductive Health Services, St. Louis, Missouri. In order to prevent this complication, one must perform an exacting pelvic examination. The use of a sound is controversial. Dilators should be introduced only a short distance through the internal os, and as much of the products of conception as possible should be aspirated. A sharp curette should be diagnostically. Various questions should be asked before the operator constructs a scheme for managing perforation. The current policy for management used at this clinic is outlined. 28 uterine perforations occurred from June 1, 1973, to June 1, 1976, among 20,000 first trimester abortion patients at Reproductive Health Services, St. Louis, Missouri. The management of such perforations should depend on the site of the perforation and the completeness of the abortion. These questions should also be answered: 1) How many weeks pregnant is the patient? 2) Is there extragenital injury? 3) Is there hematoma formation or evidence of continuing intraperitoneal blood loss? The laparascope is valuable in evaluation of the perforation damage and in determining if laparatomy is necessary. If bleeding is extensive, laparotomy is indicated for uterine and vessel repair which may even involve hysterectomy. If the perforation is discovered before removal of all products of conception, the plan depends on the site of the perforation. If vital signs are steady either 1) the patient may be returned to the procedure room and a 2nd evacuation performed, avoiding the area of perforation; or 2) the patient may be admitted to hospital for laparascopic study and evaluation for a 2nd vaginal evacuation. If perforation seems to be lateral, with intraabdominal bleeding, the patient should be hospitalized at once for close observation.
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