Bedside ultrasound in the diagnosis of uterine rupture following surgical abortion
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CASE REPORT
Bedside ultrasound in the diagnosis of uterine rupture following surgical abortion Charlotte Derr & Melinda Henry
Received: 25 June 2012 / Accepted: 8 August 2012 / Published online: 22 August 2012 # Am Soc Emergency Radiol 2012
Abstract Reports of uterine rupture following surgical abortion are rare but may result in hemorrhage, sepsis, and even death. In this unique case, we describe how a transabdominal pelvic ultrasound performed at the bedside by an emergency department physician identified uterine rupture with retained products of conception and led to an emergent laparotomy and hysterectomy. This case illustrates how bedside ultrasound may be used in patients presenting with abdominopelvic pain following surgical abortion to shorten the time to definitive treatment and ultimately lower the morbidity and mortality associated with a diagnosis of lifethreatening uterine rupture. Keywords Ultrasound . Uterine rupture . Surgical abortion
Case report A 29-year-old female presented to the emergency department with severe abdominal and pelvic pain after an elective surgical abortion. The patient was gravida 5 para 4 and at 21 weeks gestation. The patient reported 10/10 nonradiating lower abdominal pain and vaginal bleeding. Her medical
Electronic supplementary material The online version of this article (doi:10.1007/s10140-012-1069-5) contains supplementary material, which is available to authorized users. C. Derr (*) Emergency Medicine Residency Program, University of South Florida, 1 Davis Blvd, Suite 504, Tampa, FL 33606, USA e-mail: [email protected] M. Henry University of South Florida, Tampa, FL, USA
history included seasonal allergies. There was no other past surgical history. On physical examination, she was afebrile, with a blood pressure of 104/60 mmHg, pulse of 108 beats per minute, and respirations of 22 breaths per minute. The patient appeared to be in significant discomfort secondary to pain. There was diffuse tenderness across the lower abdomen, and a gravid uterus was palpable. Laboratory studies revealed a white blood cell count of 22.0 K/μl with left shift, platelets of 150 K/μl, sodium of 130 meq/L, potassium of 3.3 mmol/L, and an albumin level of 2.8 g/dl. The remaining blood chemistries and coagulation studies were otherwise unremarkable. A transabdominal pelvic ultrasound (TAPUS) performed by an emergency physician shortly after the patient's arrival showed a 5.79×6.17-cm structure with an echogenic border located in the lower abdomen just inferior to the uterus (Figs. 1 and 2). The structure resembled a fetal head, and a presumptive diagnosis of uterine rupture was made. A transvaginal ultrasound was unable to be performed secondary to patient discomfort. The obstetrics team was consulted, and intravenous antibiotics were administered. The patient was taken to the operating room for an emergent laparotomy where retained fetal parts, including the fetal head, were found intra-abdominally. The preoperative diagnosis of uterine rupture was confirmed, and a total hysterectomy was
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