Traumatic Perforation of the Uterus

Summary The clinical features and management of 40 cases of traumatic perforation of the uterus have been reviewed. Of these 40 cases, 20 were emergency admissions. Perforation of the uterus is more common in the diagnostic group than in the incomplete abortion group. However, the incidence is greater in missed and therapeutic abortions than in either of the above groups, although the numbers are much smaller. The curette was more frequently implicated in perforation of the incomplete abortion cases, whereas it was the dilator or the sound that held the major responsibility in the diagnostic group. In 10 of the 20 patients referred to the hospital, the perforation was associated with removal or insertion of a Gräfenberg ring. In this study it has not been possible to follow‐up those patients who have subsequently become pregnant. Although there are reports of patients who have had an uneventful pregnancy after perforation of the uterus (Heineck, 1908, and Rosenfeld, 1954), much will depend on the extent of the initial injury and the nature of its repair. The importance of having an accurate knowledge of the position and size of the uterus prior to instrumentation should be evident from this report. Such information can usually be ascertained clinically, particularly in the anaesthetized patient; additional useful information can be obtained by careful use of the uterine sound. In general, providing that the patient's condition is good and there has been no obvious trauma to intra‐abdominal structures, cases can be observed in a suitable institution where special facilities are available. However, should there be deterioration, or an inadequate response to treatment, immediate laparotomy must be performed, because the risks of treating such a patient conservatively far outweigh those entailed in the performance of laparotomy.