Uterine perforation during gynecologic procedures
- Barbara S Levy, MD, FACOG
Barbara S Levy, MD, FACOG
- Vice President for Health Policy
- American College of Obstetricians & Gynecologists
Uterine perforation is a potential complication of all intrauterine procedures and may be associated with injury to surrounding blood vessels or viscera (bladder, bowel) [1,2]. In addition, uterine perforation and associated complications can result in hemorrhage or sepsis. The risk of uterine perforation is increased by factors that make access to the endometrial cavity difficult (eg, cervical stenosis) or alter the strength of the myometrial wall (eg, pregnancy, menopause).
The prevention, diagnosis, and management of uterine perforation during gynecologic procedures will be reviewed here. Other complications of uterine surgery are discussed separately. (See "Complications of gynecologic surgery" and "Overview of hysteroscopy" and "Overview of pregnancy termination".)
Uterine perforation — The incidence of uterine perforation is generally based upon self-report by surgeons. In addition, many perforations are not recognized or confirmed, so it is likely that any reported incidence is an underestimate.
In most studies, hysteroscopy is complicated by confirmed uterine perforation in approximately 1 percent of operative procedures. There are fewer perforations during diagnostic hysteroscopy. (See "Overview of hysteroscopy", section on 'Uterine perforation'.)
During dilation and curettage for disorders not related to pregnancy, perforation has been reported in approximately 0.3 percent of premenopausal patients and 2.6 percent in the postmenopausal patients. (See "Dilation and curettage", section on 'Uterine perforation'.)
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- Uterine perforation
- Associated hemorrhage or visceral injury
- RISK FACTORS
- Pre-procedure preparation
- - Informed consent
- - Pre-procedure evaluation
- - Cervical preparation
- - Treatment of vaginal atrophy
- Preventive measures during the procedure
- - Uterine position
- - Difficult cervical dilation
- Safe use of operative instruments
- PERIOPERATIVE PRESENTATION OF UTERINE PERFORATION
- - During the procedure
- - Post-procedure clinical manifestations
- - Evaluation
- - Candidates for observation
- - Criteria for surgical management
- - Abdominal exploration
- - Completing the original procedure
- Post-procedure monitoring
- DELAYED PRESENTATION
- EFFECTS ON FUTURE REPRODUCTION
- SUMMARY AND RECOMMENDATIONS