مرکز منطقه ای اطلاع رساني علوم و فناوري - Gynecologic minor interventions and uterine perforation

Abstract :

Aim: Cervical dilatation and curettage, cervical dilatation and evacuation, and hysteroscopy, termed minor surgical interventions, are the most common performed surgical procedures in gynecology. Although they are safe and feasible, they are related to uterine perforation which is rare and devastating. Additionally, there is a lack of policy on management of uterine perforation. So we aimed to evaluate the medical charts of patients who underwent minor gynecological interventions to determine the incidence, management and risk factors related to uterine perforation during those interventions.Materials and Methods: The medical charts of patients who underwent minor gynecologic interventions between 2010-2013 in our clinic were assessed and among them cases with uterine perforation were further evaluated.Results: In the 3 years of the study period, 5009 minor gynecological procedures were performed and 15 (0.3%) of them were complicated by uterine perforation. Of those, 3809 women underwent cervical dilatation and curettage, with 8 perforations (0.21%). 1361 women underwent hysteroscopy with 3 perforations (0.22%). 839 patients underwent cervical dilatation and evacuation, and sustained 4 perforations (0.47%). Among the patients with uterine perforation, 4 of them were managed conservatively and 11 were managed surgically. Intestinal serosal injury was detected in 2 of the 11 surgically managed patients. Residents performed the minor gynecologic interventions in 14 of the 15 uterine perforation cases. Conclusion: Although minor gynecologic interventions are considered safe and feasible, it should be kept in mind that uterine perforation might occur despite all precautions. Surgeons should be vigilant to recognize probable uterine perforation and not cause further complications during minor gynecologic interventions.