Management of uterine perforations in connection with legal abortions.

ABSTRACT

PIP: In Sweden, where abortion is legal during the first 18 weeks of pregnancy, uterine perforation is the most serious potential complication. An analysis of the 84,850 legal induced abortions performed at the six public hospitals in Stockholm, Sweden, in 1982-92 revealed 145 cases (0.17%) of uterine perforation. 49 (33.8%) of these women had experienced at least one prior induced abortion. In women where uterine size exceeded 12 weeks of pregnancy, there were only four instances (2.8%) of uterine perforation. The perforation was caused by the suction cannula in 69 women (47.0%) and by the Hegar dilator in 30 women (20.6%). Immediate exploration of the abdomen (primarily laparotomy) was performed in 69 (47.6%) of these cases; significant bleeding and/or lacerations to organs situated in the pelvis were identified in 18 (26.1%) of these women. There were no cases of intestinal perforation. The majority of injuries would have healed without laparotomy. Unless peritoneal irritation, increasing pain, and signs of blood loss are present, a conservative approach to uterine perforation is recommended.