D&C risks

Q: 26 years old patient has been taken to Obstetrics-OR for Dilatation and Curettage (D&C) for termination of molar pregnancy. The ICU team has been called due to perforation of uterus during the procedure. Pregnant uterus tends to have a higher rate of perforation?

A) True

B) False

Answer: A

Uterine perforation is the common immediate complication of D&C. As expected, it is high when emergent D&C is required such as in postpartum hemorrhage particularly in case of a molar pregnancy because uterus is more friable in molar pregnancy. 

In contrast to diagnostic D&C, pregnant uterus tends to perforate more as the uterine wall is soft and bulkier. The risk of perforation rises higher in proportion to advancement of pregnancy. 

Management is either observation or surgical, depending on the level of perforation, risk of surgical procedure, and level of available institutional support/backup.

#Ob-gyn

#surgical-critical-care

References:

1. Ben-Baruch G, Menczer J, Shalev J, et al. Uterine perforation during curettage: perforation rates and postperforation management. Isr J Med Sci 1980; 16:821.

2. Hefler L, Lemach A, Seebacher V, et al. The intraoperative complication rate of nonobstetric dilation and curettage. Obstet Gynecol 2009; 113:1268.

3. Kaali SG, Szigetvari IA, Bartfai GS. The frequency and management of uterine perforations during first-trimester abortions. Am J Obstet Gynecol 1989; 161:406.