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LETTER TO EDITOR
Year : 2002  |  Volume : 48  |  Issue : 1  |  Page : 71-2

Anterior transverse cervical rupture following intra-amniotic prostaglandin induced mid-trimester abortion.




Correspondence Address:
U Agarwal


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Source of Support: None, Conflict of Interest: None


PMID: 12082337

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Keywords: Abortifacient Agents, adverse effects,Abortion, Induced, adverse effects,Adult, Anencephaly, ultrasonography,Case Report, Cervical Ripening, Female, Human, Pregnancy, Pregnancy Trimester, Second, Prostaglandins, adverse effects,Ultrasonography, Prenatal, Uterine Rupture, chemically induced,


How to cite this article:
Agarwal U, Kriplani A, Arora V. Anterior transverse cervical rupture following intra-amniotic prostaglandin induced mid-trimester abortion. J Postgrad Med 2002;48:71

How to cite this URL:
Agarwal U, Kriplani A, Arora V. Anterior transverse cervical rupture following intra-amniotic prostaglandin induced mid-trimester abortion. J Postgrad Med [serial online] 2002 [cited 2019 Nov 15];48:71. Available from: http://www.jpgmonline.com/text.asp?2002/48/1/71/146


Sir,

A 30 years old 5th gravida with previous four full term normal vaginal deliveries was admitted at 18 weeks period of gestation for termination of pregnancy following ultrasound revealing anencephalic foetus. Physical examination revealed a uterus corresponding to 18 weeks gestational age.

After informed consent, amniocentesis was performed under ultrasound guidance. Ten ml of amniotic fluid was

removed and same amount of injection of 15 methyl PGE2a containing 2.5mg of the drug was instilled. Uterine contractions started in one hour. Vital signs were recorded. After six hours, per abdomen examination revealed presence of good uterine contractions and vaginal examination demonstrated slight bleeding with 3 cm dilated and fully effaced cervix.

Artificial rupture of membranes was done. Fourteen hours following the procedure, she aborted an anencephalic female foetus of 200gms.

Patient continued to bleed after placental expulsion in presence of a well contracted uterus. Per-speculum examination revealed a 5cm transverse tear involving the anterior lip of the cervix extending on both sides. Bimanual examination revealed that the defect did not extend through the internal cervical os. Under intravenous sedation the repair of defect was accomplished vaginally after placing a number 8 Hegars dilator through the external os into the uterine cavity. She did not require any blood transfusion. The post-operative course was uneventful.

Transverse cervical rupture in association with elective mid-trimester abortion is an uncommon but potentially serious complication. Such lacerations not only increase the immediate post-abortal morbidity but also may adversely influence future reproductive performance. Cervico-vaginal fistulas may form through which women may menstruate, abort or even bear children.[1]

The exact incidence of such a complication is not known. Wentz et al[1] in their series of 102 elective mid-trimester abortions with prostaglandins reported the incidence of transverse cervical rupture to be 2%. In both these cases the posterior lip of cervix was involved. Kajanaja et al[2] in their experience of 412 patients with elective mid-trimester abortion with prostaglandins reported the incidence of this complication to be 2.7%. Three cases had posterior cervical rupture, one had anterior rupture and one had lateral wedge shaped tear extending to external os. Similarly, isolated cases of prostaglandin induced cervical rupture have been

described.[3],[4]

The mechanism of this aberrant cervico uterine response is debatable. Skajaa[5] has suggested that rupture occurs when the external os is relatively inelastic. It has been observed by Wentz et al[1] that the cervix feels more rigid during PGF2a induced abortions then with hypertonic saline. It is unknown whether this represents active cervical contractions or an alteration in the status of cervical connective tissue as a result of administered prostaglandins. If PGF2a does cause even a mild degree of cervical contraction then this agent may not be ideal for induction of mid-trimester abortions because of an inability to control the force of uterine contractions in the presence of cervix resistant to dilatation.

 
 :: References Top

1.Wentz AC, Thomson BH, King TM. Posterior cervical rupture following prostaglandin induced mid-trimester abortion. Am J Obstet Gynaecol 1973;115:1107-10.  Back to cited text no. 1    
2.Kajanaja D, Jungner G, Widhalm O, Karjalainen O, Seppala M. Rupture of cervix in prostaglandin abortions. J Obstet Gynaecol Br Commonw 1974;81:242-4.  Back to cited text no. 2    
3.Shearman R, Smith I, Karda A. Second trimester termination by intra-uterine prostaglandin F2a. Clinical and hormonal results with observations on induced lactation and chronoperiodicity. J Reprod Med 1972;9:448-52.  Back to cited text no. 3    
4.Bradley-Watson PJ, Beard RJ, Craft IL. Injuries of the cervix after induced mid trimester abortion. J Obstet Gynaecol Br Commonw 1973;80:284-5.  Back to cited text no. 4    
5.Skajaa T: Central Spontaneous Rupture of The Cervix Uteri A Complication of Induced Abortion. Acta Obstet Gynaecol Scand 1961;40:68-76.  Back to cited text no. 5    



This article has been cited by
1 Silent rupture of unscarred uterus: An unusual presentation at second trimester abortion
Malhotra, N., Chanana, C.
Archives of Gynecology and Obstetrics. 2007; 275(4): 283-285
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2 Combined bladder and uterine rupture following prostaglandin-induced midtrimester abortion: an unreported event
Agarwal U, Nanda S, Sangwan K, Singh R
Acta Obstetricia Et Gynecologica Scandinavica. 2003; 82(10): 974-975
[Pubmed]



 

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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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