Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Obstetrics and Gynaecology, Klerksdorp Hospital, Klerksdorp, South Africa.
Afr Health Sci. 2022 Mar;22(1):180-182. doi: 10.4314/ahs.v22i1.23.
The risk of uterine perforation during manual vacuum aspiration (MVA) is reduced by using Karman cannula (which has a rounded tip) during the procedure.
A 35-year-old multigravida at 13 gestational weeks presented with vaginal bleeding of a day duration and ultrasound evidence of retained products of conception suggestive of incomplete miscarriage. The patient was rhesus D positive and stable. She had MVA which was performed using Karman cannula, and developed severe vaginal bleeding. The differential diagnoses were incomplete uterine evacuation and uterine perforation.
During a laparotomy in Lloyd-Davies position, haemoperitoneum and six uterine perforations on the anterior and fundal parts, each approximately 5 mm in length (Figure 1), were found. The perforations were repaired and a check uterine curettage under oxytocic cover showed an empty uterus. The abdominal cavity was washed and closed. She was transfused three units of red blood cell concentrate and had a normal six weeks follow-up.
When an instrument inserted into the uterus is pushed beyond the estimated depth of the uterus, a perforation must be suspected and the condition may be managed conservatively. A surgical procedure complicated by surgeon's loss of perception (in this case tactile) of tissues' anatomy is hazardous.
在手动吸引（MVA）过程中，使用 Karman 管（其尖端为圆形）可以降低子宫穿孔的风险。
一名 35 岁的多产妇，妊娠 13 周，出现阴道出血 1 天，超声检查提示有妊娠产物残留，提示不完全流产。患者为 RhD 阳性，情况稳定。她接受了使用 Karman 管的 MVA，但出现严重的阴道出血。鉴别诊断为不完全子宫排空和子宫穿孔。
在 Lloyd-Davies 体位下进行剖腹探查时，发现腹腔积血和子宫前壁及底部的 6 处穿孔，每个穿孔约 5 毫米长（图 1）。穿孔被修复，并在催产素覆盖下进行了子宫检查性刮宫，显示子宫排空。腹腔冲洗后关闭。她输注了 3 单位浓缩红细胞，6 周后恢复正常。
当插入子宫的器械被推超过子宫的估计深度时，必须怀疑穿孔，并可能需要保守治疗。手术过程中，如果外科医生失去对组织解剖结构的触觉感知（在这种情况下），则会很危险。
