Perforation uterus: a life threatening complication of second trimester suction and evacuation

Uterine perforation though a common complication but can have potentially catastrophic consequences for women ,like in our case where foetal skull was found which was missed in first exploration. We, hereby present a case of 24-year-old G2P1L1 referred from peripheral centre with a known case of poliomyelitis ,with profuse vaginal bleeding with Hb of 3.4gm/dl following induced second trimester suction and evacuation at 13 weeks of gestation with Exploratory laprotomy done for perforation in the same sitting on the same day. Patient’s Ultrasound abdomen and pelvis done in our centre detected retained products of conceptus (foetal skull of 2.82cm approx 15wk1d gestation and upper portion of cervical spine in cul-de-sac). Exploratory laprotomy with Dilatation and evacuation was done after initial treatment with blood and blood concentrates after one week because the pouch of douglus collection was not resolving. These complications can be associated with severe morbidity. So appropriate training with supervision, assessment of risk factors and the generous use of cervical preparation are the features which can all help to reduce the risk of perforation and complications associated with MTP. Exercising caution in high risk cases should be compulsory and seeking help from senior gynaecologists as well as other specialties in a timely manner can, not only help to decrease morbidity but also prevent any long-term sequelae. Standardisation of management is vital as considerable variation between the operators currently exist.