Sonographic Diagnosis of Uterine Perforation Following Suction Curettage

Js, Cunat; Mg, Dunne; Butler, Melvin L.

doi:10.1002/jcu.1870120211

Cited by 4 publications

(3 citation statements)

References 2 publications

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“…Originally sonography was used to depict in real time any concurrent secondary occurrences associated with uterine perforation following the clinical suspicion of perforation at curettage. Thus sonographic documentation of free fluid in the pelvis9, 10, loops of bowel within the myometrial wall11, extrauterine fetal parts12 or intraoperative presence of the curette within the myometrium13 have confirmed clinically suspected uterine perforation indirectly9–13. Similarly, sonographic evidence of an intrauterine device in the bladder is indicative of perforation or, less likely, migration of the device through uterine tissue1, 2.…”

Section: Discussionmentioning

confidence: 99%

“…Given that iatrogenic uterine perforation is usually diagnosed clinically at the time of the injury, the literature regarding associated sonographic findings is relatively sparse9–13. Originally sonography was used to depict in real time any concurrent secondary occurrences associated with uterine perforation following the clinical suspicion of perforation at curettage.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Transvaginal sonographic findings of a large intramural uterine hematoma associated with iatrogenic injury sustained at termination of pregnancy

Sherer

Gorelick

Gabbur

et al. 2007

Ultrasound in Obstet & Gyne

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CASE REPORTA 21-year-old woman, gravida 1 para 0, presented to the emergency room at State University of New York, Downstate Medical Center with right lower abdominal pain radiating to her back, and nausea and vomiting, 3 days after surgical termination of pregnancy at 14 weeks' gestation. Her medical history was unremarkable. The patient denied a history of sexually transmitted disease, and her recent cervical cytology was normal. Three days before presentation the patient had undergone an elective outpatient termination of pregnancy by dilatation and suction curettage. The presence of a 14-week intrauterine gestation had been confirmed by ultrasound scan before the procedure. The preoperative ultrasound examination did not reveal any abnormal uterine findings, including any evidence of uterine leiomyomata. The patient had been told that the procedure, which was not performed under real-time ultrasound guidance, was uneventful. She was given routine oral antibiotics (doxycycline 100 mg twice daily for 5 days and methergine 0.2 mg twice daily for 2 days). An immediate postprocedure ultrasound examination was not obtained following the termination of pregnancy.Physical examination on presentation revealed a healthy woman. She was afebrile, with blood pressure 103/66 mmHg, and pulse 82 beats per min. Her abdomen was soft, yet with marked tenderness of the lower abdomen but no signs of peritoneal irritation. Bimanual pelvic examination disclosed a soft tender uterus enlarged to 8 weeks' size. Both adnexa were normal. The cervix was long and closed yet motion tenderness was present. Laboratory results revealed a hemoglobin level of 10.3 g/dL, hematocrit 29.9%, a white blood cell count of 9.64 × 10 9 d/L and a platelet count of 227 × 10 9 d/L. Serum creatinine, blood urea nitrogen, electrolyte levels, prothrombin time and partial thromboplastin time were normal, and the serum betahuman chorionic gonadotropin (beta-hCG) level was 5651 mIU/mL. Transvaginal ultrasonography showed an acutely retroflexed uterus with a normal endometrial echo. Both adnexa were normal. No free fluid was noted in the cul-de-sac. A 5 × 5-cm, well circumscribed mass with a hypoechoic center was noted in the anterior aspect of the lower uterine segment (Figure 1). Color Doppler imaging

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transvaginal sonographic findings of a large intramural uterine hematoma associated with iatrogenic injury sustained at termination of pregnancy

Sherer

Gorelick

Gabbur

et al. 2007

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

show abstract

“…Previously described sonographic findings associated with uterine perforation include indirect secondary occurrences depicted after clinical suspicion at or close to the time of perforation. Thus, sonographic depictions of free fluid in the pelvis, 7,8 loops of bowel within the myometrial wall or endometrial cavity, 9,10 parts, 11 or the intraoperative presence of the curette within the myometrium 12 have indirectly confirmed clinically suspected uterine perforation. Similarly, postinsertion sonographic evidence of an ex utero located intrauterine contraceptive device or brachytherapy tandem is considered consistent with uterine perforation.…”

Section: Discussionmentioning

confidence: 99%

Sonographic and Multiplanar Computed Tomographic Findings of Large Uterine Perforation 2 Weeks After First-Trimester Pregnancy Termination

Sherer

Novac

Dalloul

et al. 2009

Journal of Ultrasound in Medicine

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erforation of the uterus usually results from either iatrogenic or, less frequently, spontaneous occurrences. 1-6 Iatrogenic etiologies include perforations occurring during dilation and curettage, hysteroscopy, and insertion of intrauterine contraceptive devices or brachytherapy tandems or as a result of endometrial ablation. 1-3 Spontaneous etiologies include pyometra, gestational trophoblastic disease, placenta accreta, and rarely degeneration of a myoma and uterine infarction. [3][4][5][6] Procedure-related uterine perforation is usually considered and diagnosed clinically at the time of injury, hence the relative sparse literature pertaining to imaging findings associated with uterine perforation. We report an unusual case in which uterine perforation was confirmed by sonography and computed tomography 2 weeks after pregnancy termination at 13 weeks' gestation.

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Sonographic identification of an unusual complication of midtrimester pregnancy termination: Unrecognized intra‐abdominal extrusion of fetal parts

Bowerman

Pennes

Jongeward

1988

J of Clinical Ultrasound

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The incidence of uterine perforation during midtrimester dilatation and evacuation is 0.2% to 0.4%.1-3 We describe an unusual secondary complication of uterine perforation, that of unrecognized extrusion of fetal parts with "migration" to an extrapelvic portion of the maternal peritoneal cavity. The key role of ultrasound in detecting this clinically unsuspected complication is discussed. CASE REPORTA 25-year-old woman (G3P2) underwent an uneventful elective pregnancy termination of a 16-week gestation by dilatation and evacuation (D&E) under general anesthesia. Two days later she was admitted with left lower quadrant pain, fever, and a hematocrit of 29.1. A curette was passed to 13 cm, eliciting back pain but yielding no tissue. Laparoscoy revealed considerable intra-abdominal blood, and immediate laparotomy confirmed a 10-cm posterior uterine tear. Following uterine repair, the remainder of the pelvis and accessible abdominal contents were thoroughly inspected and considered normal.Despite antibiotic coverage, a postoperative fever persisted on postoperative day 6, and the left lower quadrant pain was increasing. Pelvic examination was unrevealing and pelvic sonography was requested. While no pelvic abnormal-

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Sonographic Diagnosis of Uterine Perforation Following Suction Curettage

Cited by 4 publications

References 2 publications

Transvaginal sonographic findings of a large intramural uterine hematoma associated with iatrogenic injury sustained at termination of pregnancy

Transvaginal sonographic findings of a large intramural uterine hematoma associated with iatrogenic injury sustained at termination of pregnancy

Sonographic and Multiplanar Computed Tomographic Findings of Large Uterine Perforation 2 Weeks After First-Trimester Pregnancy Termination

Sonographic identification of an unusual complication of midtrimester pregnancy termination: Unrecognized intra‐abdominal extrusion of fetal parts

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