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Keywords:

  • complications;
  • prevention;
  • risk factors;
  • risk management points;
  • uterine perforation

Key content

  • Uterine perforation is an uncommon but potentially serious complication of uterine manipulation, evacuation of retained products of conception or termination of pregnancy (TOP), hysteroscopic procedures and during coil insertion.
  • Factors that increase the risk of uterine perforation include uterine anomalies, infection, recent pregnancy and postmenopause. TOP is the most common procedure associated with uterine perforation.
  • Prevention of uterine perforation is favoured, although if it occurs, initial recognition together with immediate and ongoing management is key to reducing morbidity, mortality and long-term consequences.
  • It is important that surgeons performing surgical TOP are adequately trained. The experience of the surgeon results not only in fewer perforations but also in the early recognition of uterine injury.
  • Uterine perforation is a complication that is well recognised by all gynaecologists, although subsequent assessment and management needs to be standardised.

Learning objectives

  • To be aware of the incidence of uterine perforation and the potential serious complications that can result.
  • To identify the risk factors of uterine perforation, the mechanism of injury and how to potentially prevent it from occurring.
  • To increase awareness of this complication and to propose a standardised management protocol if a uterine perforation occurs, together with risk management issues.

Ethical issues

  • Are women at increased risk of uterine perforation counselled adequately about the complications and consequences?
  • Are women at increased risk given the full range of alternative treatment options?