Sonographic identification of an unusual complication of midtrimester pregnancy termination: Unrecognized intra‐abdominal extrusion of fetal parts

Abstract

The incidence of uterine perforation during midtrimester dilatation and evacuation is 0.2% to 0.4%.1-3 We describe an unusual secondary complication of uterine perforation, that of unrecognized extrusion of fetal parts with "migration" to an extrapelvic portion of the maternal peritoneal cavity. The key role of ultrasound in detecting this clinically unsuspected complication is discussed. CASE REPORTA 25-year-old woman (G3P2) underwent an uneventful elective pregnancy termination of a 16-week gestation by dilatation and evacuation (D&E) under general anesthesia. Two days later she was admitted with left lower quadrant pain, fever, and a hematocrit of 29.1. A curette was passed to 13 cm, eliciting back pain but yielding no tissue. Laparoscoy revealed considerable intra-abdominal blood, and immediate laparotomy confirmed a 10-cm posterior uterine tear. Following uterine repair, the remainder of the pelvis and accessible abdominal contents were thoroughly inspected and considered normal.Despite antibiotic coverage, a postoperative fever persisted on postoperative day 6, and the left lower quadrant pain was increasing. Pelvic examination was unrevealing and pelvic sonography was requested. While no pelvic abnormal-