The perforated uterus 2013 Flashcards
Incidence of uterine perforation at hysteroscopic surgery
1.6%
What proportion go perforations caused by fitting IUD with involve abdominal or pelvic viscera?
Bowel injury
15%
3-7.5%
What proportion of women having clinical recongonised perforation following TOP had hysterectomy?
9%
Most common site of uterine perforation?
Anterior abdominal wall 40%
Most common instrument to cause perforation?
Suction cannula
Risk factors of uterine perforation
Advanced gestation when TOP is performed
ERPC for postpartum haemorrhage
Parous uterus
Recent pregnancy in the past 6 months
Small postmenopausal uterus
Tight postmenopausal cervix
Uterine cavity distorted by fibroids
Intrauterine synechiae or adhesions
Pyometra
Infection
Position and attitude of the uterus
Retroverted, acutely anteverted or retroflexed uterus
Uterine anomalies
The scarred uterus (previous uterine surgery)
Risk of uterine perfromation for ERPC for PPH?
5.1-5.7%
Risk perforation with TOP
0.52%
Risk perforation with PMB Ix with hysteroscopy
0.2-2%
prevention uterine perfromation
If premenopausal, OP hysteroscopy - give prostaglandins or misoprostol
Sae with sTOP
Slow careful cervical dilatation
Consider USS guidance
Which perforations can be managed conservatively
< 5mm
When laparoscopy required
> 5mm, tissues grasped avulsion attempted, bleeding
How to manage at laparoscopy?
Insert catheter
Small perforation with little bleeding do not need repair. If small bleed can cauterisation with diathermy
Larger - suturing
When to consider laparotomy
Continue haemorrhage, enlarging broad ligament haematoma
Needs suture but not laparoscopic surgeon available
Flow diagram of uterine perforation
