Uterine Perforation - A Spontaneous Recurrence

Abstract

A 30-year-old female, gravida-3, para–1, live–1, abortion–1, admitted in Sri Ramachandra Institute of Higher Education and Research (SRIHER) at 37 weeks and 6 days of gestation–planned for elective lower segment Caesarean section. Growth scan done at 37 weeks showed fetal growth restriction (estimated fetal weight-EFW at 3rd centile) with uterine artery Doppler showing high resistance flow. She had mild anaemia (haemoglobin 9g / dl), B negative blood group, indirect Coomb’s test was negative, and injection anti D was not given antenatally. She had an uneventful antenatal period. In 2013, at 23-years of age, she was referred to SRIHER with high grade fever and lower abdominal pain for one-week duration. She had history of dilatation and curettage done one week back for missed abortion. Pelvic ultrasound and computed tomography showed an adnexal mass with air pockets suggestive of a pelvic abscess. She was taken up for emergency laparoscopy which revealed a pelvic abscess walled off by omental and bowel adhesions along with perforation on the upper part of the posterior surface of uterus with extensive sloughing. In view of the nulliparous status of the patient conservative management was opted for and decision was taken to preserve the uterus under stepped up antibiotic cover. Thorough peritoneal wash was given, and intraperitoneal drain was kept. Patient was intensively monitored. Though she developed features of evolving sepsis prompt critical care management resulted in her steady recovery without undergoing hysterectomy.1 In 2018, (G2A1) patient was planned for elective lower segment Caesarean section (LSCS) at 37 weeks. However, she came to our institute at 33 weeks and 4 days of gestation in early labour. In view of history of previous septic abortion with uterine perforation, she delivered by emergency lower segment Caesarean section. Baby was a late preterm girl, weighing 1.9 Kg, cried immediately at birth. Placenta and membranes were delivered in toto. Intraoperative period was uneventful. Posterior wall of uterus did not show any signs of the previous perforation. Postoperative period was uneventful.