Publication

Abstract : Confirmation of intra-uterine pregnancy as early as possible should be made a routine and a part of ideal antenatal care which most of the rural areas in India lack now a days. Post-abortal collapse is one of the deadly nightmares of the obstetrician. The abortion related complications rate including all sources of care including emergency department and the original abortion facility is estimated to be about 2%.[1] Mostly, common complications encountered are minor complications such as pain, bleeding, infection, and post-anesthesia complications. Major complications include namely uterine atony and subsequent hemorrhage, uterine perforation, injuries to adjacent organs (bladder or bowels), cervical laceration, failed abortion, septic abortion, and disseminated intravascular coagulation (DIC).[2][3][4] Due to lack of early trimester scan and intra uterine pregnancy confirmation, unnecessary interventions like evacuation are being done for mis-diagnosed ectopic pregnancy landing the patient into life threatening complications. In our case study, we report a case of 36 years old female, G5P2L2A2 who presented to our emergency department with severe abdominal pain and bleeding per vaginum post D&E for first trimester abortion. No prior ultrasonographic detection of intra-uterine pregnancy was done before D&E. on arrival patient was in a state of shock. Her Beta-HCG level measured 8000 mIU/ml and ultrasound showed massive hemoperitoneum with uterine perforation. Patient was taken for emergency laparotomy and intra-operatively ruptured right tubal ectopic pregnancy was seen with uterine and gut perforation. Patient was successfully managed through resuscitative efforts and emergency laparotomy followed by right salpingectomy and left tubal ligation.