Uterine perforation during intrauterine procedures and its management

Czech version

Authors: D. Driák ¹; Borek Sehnal ^1,2; Jarošová L. ¹; Dvořáčková K. ¹
Authors‘ workplace: Gynekologicko-porodnické oddělení, Nemocnice Neratovice ¹; Gynekologicko-porodnická klinika 1. LF UK a FN Bulovka, Praha ²
Published in: Ceska Gynekol 2022; 87(4): 295-301
Category: Review Article
doi: https://doi.org/10.48095/cccg2022295

Overview

Objective: Uterine perforation is a potential, not rare complication of all intrauterine procedures and may be associated with injury of surrounding organs and structures. The incidence, risk factors, possible prevention, diagnosis, management and impact on future reproduction is reviewed here. Methods: Systematic review of available sources on the topic was carried out using the PubMed database and textbooks of Czech authors. Conclusion: Some risk factors that make access to the uterine cavity difficult may be prevented, however, others remain unpreventable. For patients in whom the perforation occurred during sondage, dilatation or insertion of blunt and cold instrument, without significant bleeding and who are hemodynamically stable, observation is recommended rather than immediate abdominal exploration. The exception are young women planning pregnancy in whom endoscopic suture is indicated. Abdominal exploration is required in patients who have been injured by electrosurgical or sharp device, laser, vacuum curette, who are hemodynamically unstable or show signs of severe bleeding or visceral injury.

Keywords:

injury – hysteroscopy – risk factors – intrauterine device – uterine perforation – dilatation and curettage – pregnancy termination

Sources

1. Pasini A, Belloni C. Intraoperative complications of 697 consecutive operative hysteroscopies. Minerva Ginecol 2001; 53 (1): 13–20.

2. Kaali SG, Szigetvari IA, Bartfai GS. The frequency and management of uterine perforations during first-trimester abortions. Am J Obstet Gynecol 1989; 161 (2): 406–408. doi: 10.1016/0002-9378 (89) 90532-2.

3. Chandi A, Jain S, Yadav S et al. Vaginal evisceration as rare but a serious obstetric complication: a case series. Case Rep Womens Health 2016; 10: 4–6. doi: 10.1016/j.crwh.2016.05.001.

4. Jansen FW, Vredevoogd CB, van Ulzen K et al. Complications of hysteroscopy: a prospective, multicenter study. Obtet Gynekol 2000; 96 (2): 266–270. doi: 10.1016/s0029-7844 (00) 0 0865-6.

5. Agostini A, Cravello L, Bretelle F et al. Risk of uterine perforation during hysteroscopic surgery. J Am Assoc Gynecol Laparosc 2002; 9 (3): 264–267. doi: 10.1016/s1074-3804 (05) 60401-x.

6. Xia E, Xia E, Chen F. Severe complications of hysteroscopic surgeries: an analysis of 35 cases. Zhonghua Fu Chan Ke Za Zhi 2001; 36 (10): 596–599.

7. Holub Z, Kužel D et al. Minimálně invazivní operace v gynekologii. 1. vyd. Praha: Grada Publishing 2005.

8. Aydeniz B, Gruber IV, Schauf B et al. A multicenter survey of complications associated with 21,676 operative hysteroscopies. Eur J Obstet Gynecol Reprod Biol 2002; 104 (2): 160–164. doi: 10.1016/s0301-2115 (02) 00106-9.

9. Augustin G, Mijatovic D, Zupancic B et al. Specific small bowel injuries due to prolapse through vaginal introitus after transvaginal instrumental gravid uterus perforation: a review. J Obstet Gynaecol 2019; 39 (5): 587–593. doi: 10.1080/01443615.2018.1540561.

10. Driák D. Antikoncepce. 1. vyd. Praha: Galén 2020.

11. Barnett C, Moehner S, Minh TD et al. Perforation risk and intra-uterine devices: results of the EURAS-IUD 5-year extension study. Eur J Contracept Reprod Health Care 2017; 22 (6): 424–428. doi: 10.1080/13625187.2017.1412427.

12. Bui BN, Lanses SF, Gibreel A et al. Endometrial injury for pregnancy following sexual intercourse or intrauterine insemination. Cochrane Database Syst Rev 2021; 3 (3): CD011424. doi: 10.1002/14651858.CD011424.pub3.

13. Lensen SF, Manders M, Nastri CO et al. Endometrial injury for pregnancy following sexual intercourse or intrauterine insemination. Cochrane Database Syst Rev 2016; (6): CD011424. doi: 10.1002/14651858.CD011424.pub2.

14. Nastri CO, Lensen SF, Gibreel A et al. Endometrial injury in women undergoing assisted reproductive techniques. Cochrane Database Syst Rev 2015; (3): CD009517. doi: 10.1002/14651858.CD009517.pub3.

15. Chang HM, Shen CJ, Lin CY et al. Uterine perforation and bowel incarceration following surgical abortion during the first trimester. Taiwan J Obstet Gynecol 2008; 47 (4): 448–450. doi: 10.1016/S1028-4559 (09) 60016-4.

16. Shveiky D, Rojansky N, Revel A et al. Complications of hysteroscopic surgery: “Beyond the lerning curve“. J Minim Invasive Gynecol 2007; 14 (2): 218–222. doi: 10.1016/j.jmig.2006.07.019.

17. Macků F et al. Kompendium gynekologic- kých operací. 1. vyd. Praha: Grada Publishing 1995.

18. Phillips DR, Nathanson HG, Milim SJ et al. The effect of dilute vasopressin solution on the force needed for cervical dilatation: a randomized controlled trial. Obstet Gynecol 1997; 89 (4): 507–511. doi: 10.1016/S0029-7844 (97) 00006-9.

19. Hobo R, Netsu S, Koyasu Y et al. Bradycardia and cardiac arrest caused by intramyometrial injection of vasopressin during a laparoscopically assisted myomectomy. Obstet Gynecol 2009; 113 (2 Pt 2): 484–486. doi: 10.1097/AOG.0b013e318187e795.

20. Leibner EC. Delayed presentation of uterine perforation. Ann Emerg Med 1995; 26 (5): 643–646. doi: 10.1016/s0196-0644 (95) 70019-6.

21. Jhobta RS, Attri AK, Jhobta A. Bowel injury following induced abortion. Int J Gynaecol Obstet 2007; 96 (1): 24–27. doi: 10.1016/ j.ijgo.2006.07.010.

22. Chawla S, Jain S, Suneja A et al. Degloving injury of bowel: an unheard complication of surgical abortion. J Clin Diagn Res 2016; 10 (5): QD01–QD02. doi: 10.7860/JCDR/2016/17329.787.

23. Samantray SR, Mohapatra I. Small bowel prolapse a rare complication following unsafe abortion. Cureus 2020; 12 (10): e11260. doi: 10.7759/cureus.11260.

24. Akaba GO, Adeka BI, Ogolekwu PI. Multiple visceral injuries suffered during an illegal induced abortion – a case report. Eur J Contracept Reprod Health Care 2013; 18 (4): 319–321. doi: 10.3109/13625187.2013.805407.

25. Matsubara S, Ohkuchi A, Nonaka H et al. Prolapse of the small intestine from the uterine perforation at dilatation and curettage. Case Rep Obstet Gynecol 2014; 2014: 164356. doi: 10.1155/2014/164356.

26. Sentilhes L, Sergent F, Roman H et al. Late complications of operative hysteroscopy: predicting patients at risk of uterine rupture during subsequent pregnancy. Eur J Obstet Gynecol Reprod Biol 2005; 120 (2): 134–138. doi: 10.1016/ j.ejogrb.2004.10.010.