October 18th, 2018

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Laparoscopic Guided Dilation and Evacuation Following a Uterine Perforation: A Case Report
Authors:  Abigail Mancuso, M.D., Abbey Hardy-Fairbanks, M.D., and Rachel Mejia, D.O.
BACKGROUND: Uterine perforation is a rare complication of second trimester dilation and evacuation, and there is minimal data regarding management of this situation, especially when uterine evacuation has not yet been completed. While in the past laparotomy has been the standard to manage uterine perforation, this case represents a unique, minimally-invasive approach for managing the uterine perforation and completing the dilation and evacuation.

CASE: The patient was a 13-year-old, primigravid female with a uterine perforation occurring during dilation and evacuation, prior to complete uterine evacuation. Laparoscopy was performed, allowing for evaluation of the perforation, completion of dilation and evacuation with laparoscopic guidance, and repair of the uterine defect.

CONCLUSION: Laparoscopy is associated with less morbidity than is laparotomy. Laparoscopy offers a minimally invasive approach in cases of uterine perforation in a stable patient during dilation and evacuation to both evaluate and repair the perforation. It also provides a useful way to guide the completion of the uterine evacuation.
Keywords:  abortion techniques, induced abortion, laparoscopy, pregnancy, therapeutic abortion, uterine perforation
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