Uterine Perforation

Definition - What does Uterine Perforation mean?

Uterine perforation is the development of a puncture in the wall of the uterus that typically happens as a complication of gynecological procedures that involve introducing instruments into the cavity of the uterus through the vagina. A small perforation caused by a narrow instrument may not cause significant damage to the uterus and usually heals by itself without needing any treatment or causing long-term effects. However, a large perforation can lead to severe internal bleeding and damage to other organs in the pelvis. If the perforation is large enough to cause significant scarring of the uterus, it can cause infertility.

Uterine perforation should not be confused with uterine rupture, which happens typically during childbirth due to decreased strength of the uterine wall and the increased pressure inside the cavity of the uterus.

FertilitySmarts explains Uterine Perforation

Some of the procedures that are associated with a risk of uterine rupture include:

  • Insertion of an intrauterine device (IUD) for family planning (1 in 1000 insertions)
  • Assisted childbirth using surgical instruments
  • Hysteroscopy
  • Widening of the cervix
  • Taking samples or scraping of the inner uterine layer

The initial symptom of uterine rupture is often abdominal pain. With the progression of blood loss, patients may experience dizziness, palpitations, shortness of breath and sweating and if not treated promptly, they may finally collapse. Infections of the uterus or the abdominal cavity can occur as a late manifestation.

Uterine perforation can be further complicated by injury to large blood vessels that supply the organs on the pelvis and the legs. It also can lead to damage to nearby organs such as the bladder and bowel.

The chances of uterine rupture are higher if the procedure is performed by an unskilled clinician. Having a narrow cervical canal, abnormal positioning of the uterus and weakening of the wall of the uterus (during pregnancy, breastfeeding, and menopause) also increase the risk of uterine rupture.



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