Perforation and Scarring of Uterus

Perforation and Scarring of Uterus

Perforation and Scarring of Uterus when having a D&C is due to a Surgeons failure to see what they are doing during the procedure.This arises because the cervical canal and uterine cavity have variable direction and degree of curvature. Although the instruments are curved, they are not flexible and if incorrectly introduced, may create a false passage within the uterine wall or even penetrate the wall entirely.

This is especially so if the natural curve of the cavity is presumed to be forward (which is usual). When the uterus is retroverted and retroflexed, the actual curve will be backwards.

Thus minor perforations happen frequently as well as associated damage to intra-abdominal structures such as major blood vessels or loops of bowel resulting in post-operative internal bleeding or sepsis.

Uterine perforation is much more common when the wall of the has been softened by the presence of a pregnancy.

Dilation of the cervix beyond 9mm should be avoided. The reason for this is that excessive dilation, though not necessarily causing any visible tear, may result in rupture of the muscle fibers within the substance of the cervix. Such internal damage my give rise to cervical incompetence. This means that in subsequent pregnancies the cervix opens inappropriately early with miscarriage or premature delivery of the foetus. This can happen at any stage of the pregnancy after 12 weeks but most common at 16-18 weeks.