Traumatic injuries of sexual sphere after abortion

Not always an artificial abortion, carried out by medical or social reasons, runs smoothly. In a known percentage of cases it is accompanied by a number of complications, some of which are directly related to the execution of the operation, the other part is manifested in the form of complications in the postoperative period. Much greater chance of complications occur in community-acquired miscarriage. Complications associated with the execution of the operation, refer exclusively to traumatic injuries, which in some cases are located only within the womb, others are beyond the boundaries of the latter. The literature describes a significant number of cases, perforation of the uterus, accompanied by damage of abdominal cavity organs (separation of the intestine from the mesentery, multiple penetrating and non-penetrating wounds of the intestine, packing and mesentery, break the ovary and process the caecum and others).
In some cases the cause damage to the uterus and related bodies cannot be traced to overconfidence some operators, resulting in insufficient attention to the operation and use of dangerous tools such as forceps. There is sometimes observed severe cases of perforation of the uterus, produced by doctors. In rare cases injuries were very severe, but sometimes, fortunately, ended very well, can point to a single case where there was a heavy perforation not only cancer, and bladder. The injury to the bladder, was so serious that the restoration of the history of it was presented for the surgeon rather difficult task because of the bubble was only a small part of it with trigonum Lieutaudi.

Table 6
Author The perforation of the uterus with miscarriage in %
C. M. Jacobson
I. A. Zavyalov
C. Century Kisin
L. E. Sandak
I. I. Yakovlev
0,15
0,5
0,26
0,19
0,03
The frequency of perforation of the uterus, according to different authors, varies from 0.03% to 0.5% (see table. 6). However, it should be expected that this percentage will undoubtedly diminished, as part of the perforations remains unrecognized.
Cause of death for the most part is not very traumatic injury, and its effects associated with exposure of the body.
A significant role in the emergence of provadeni uterus has an abortion in late pregnancy (12-16 weeks), when the wall of the uterus already severely stretched and thinned, and the cavity its large and it is difficult to navigate when the operation.
However not in all cases the reason for the perforation of the uterus is the use of brute force and lack of operating experience. In many cases, certainly play a role of structural characteristics of fabrics of the uterus caused by infantilism and malformations, transferred inflammatory diseases, neoplasms.
In these cases, there is either excessive laxity and thinning of the uterus, or, on the contrary, coarse fabrics last.
The perforation of the uterus can occur at any intrauterine intervention (sensing, trial and treatment scraping, delete parts of the ovum and so on) and can be made of various instruments or even just your finger (Fig. 38, 39, 40).


Fig. 38. Perforation of the uterus with the extender Hegira.
Fig. 39. Perforation of the uterus by a curette.
Fig. 40. Perforation of the uterus with the extraction of a loop of intestine (autopsy preparation).

Taking into account the full amount of the factors that cause perforation of the uterus, we still believe that the main role is played morphological changes in tissues of the uterus (L. I. Chernyshev). I. L. Braude rightly points out that in a normal pregnancy, the first months require a good deal of effort uterine probe to produce a perforation of the uterus. The author conducted a corresponding experiment, which demonstrated that a perforation occurs when the load 1,5-2,5 kg
Studying all cases of provadeni cancer observed in the clinic and published in the literature, we could mention one very important fact that all heavy damage produced mainly by forceps and curette, at least - expanders, probe, etc., X. Barsky showed that the greatest number of injuries inflicted by curette and abortion tongs and least - expanders. Quite rights I. L. Braude, who recommended to withdraw the forceps and bartzaga be used only to remove parts of the ovum, is already separated by curette from the uterine wall. The best modifications aborting are forceps design R. Century of Kemarskogo and senger with round blunt ends.
The damage to the body of the uterus are found mainly in the lower segment or the bottom of it. Perforation can be made at any time of the operation of artificial abortion: in the preparatory period, when extending the cervical canal and in the process of scraping. About what happened perforation usually judged by the fact that the tool is suddenly gone to great depths, and in some cases is extracted out the seal, the loop of intestine, etc.
In most cases, abrupt changes in the state operated at the time of perforation occurs, unless caused any damage of vessels, such as uterine artery. In such cases, there is a hematoma of the broad ligament.
The recognition. The danger is not only in the perforation of the uterus, but mainly in the fact that the latter will not be promptly recognized. As a result, except perforation, and there are other complications. Depending on this, there are: 1) uncomplicated perforation of the uterus (without damage to adjacent organs) and 2) complicated by perforation, accompanied by damage of organs and sometimes removing them out (gland, colon).
It is quite clear how important it is to stop the operation, so as not to harm the patient. Made a perforation is not always seen to be operating. Meanwhile, if you are attentive opportunity not notice the perforation can be almost completely eliminated, and hence the associated serious consequences.