Obstet Gynecol Sci.  2020 Jan;63(1):102-106. 10.5468/ogs.2020.63.1.102.

Operative hysteroscopy-assisted pregnancy termination after failed surgical abortion in missed abortion of woman with complete septate uterus

• Ryu S
• Baek HW
• Lee I
• Won YB
• Kim H
• Lee JH
• Yun BH
• Park JH
• Seo SK
• Cho S
• Choi YS
• Lee BS

• KMID: 2467939
• DOI: http://doi.org/10.5468/ogs.2020.63.1.102

Abstract

First trimester surgical abortion is an effective and safe procedure. Although its failure is uncommon, congenital uterine anomaly may be considered as one of the etiologic factors in such cases. Here, we report a rare case of surgical abortion failure that was successfully managed by operative hysteroscopy-assisted dilatation and evacuation (D&E) under ultrasound guidance in a woman with complete uterine septum. The patient was referred to Severance Hospital after two consecutive surgical abortion failures even under ultrasound guidance. A missed abortion in a left-sided hemicavity of septate uterus was noted on ultrasonography. Ultrasound-guided D&E was unsuccessful because the curette could not reach the uterine cavity with the gestational sac. Operative hysteroscopy revealed insufficient communication with the left-sided cavity just above the cervical internal os of the uterine septum. After widening the communication, ultrasound-guided D&E was successfully performed.

Keyword

Uterine anomalies; Septate uterus; Missed abortion; Induced abortion; Hysteroscopy

MeSH Terms

Abortion, Induced
Abortion, Missed*
Dilatation
Female
Gestational Sac
Humans
Hysteroscopy
Pregnancy Trimester, First
Pregnancy*
Ultrasonography
Uterus*

Figure

• 

  Fig. 1 Ultrasonographic finding (A) and operative findings during hysteroscopy for dilatation and evacuation (B-D). (A) Transverse scan showing two uterine cavities with a gestational sac in the left-sided hemicavity, (B) tiny septal communication between the two hemicavities, (C) further widened communication using hysteroscopy, and (D) gestational tissues in the left hemicavity (arrowhead, uterine septum; arrow, communication between right and left hemicavities).

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  Fig. 2 T2-weighted magnetic resonance imaging (A) and operative findings during hysteroscopy for septectomy (B) (arrowhead, uterine septum; arrow, cervical septum).

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