Akademik Veri Yönetim Sistemi
Türk Alman Jinekoloji Kongresi, Antalya, Türkiye, 23 - 27 Nisan 2025, cilt.1, sa.1, ss.69-70, (Tam Metin Bildiri)
Challenges in Second-Trimester Termination: Hysterotomy
Following Medical Failure and Postoperative Hematoma
Özge Berfin Babayiğit, Ömer Faruk Öz, Can Dinç, Tuğçe Tunç
Akar, Gizem Pınar, Cem Dağdelen, İnanç Mendilcioğlu
Akdeniz University, Faculty of Medicine
We present the case of a 37-year-old pregnant woman at 14
weeks and 2 days of gestation who had been followed up at an external center
and was referred to our perinatology clinic due to ultrasound findings of right
upper limb absence, bilateral femur shortening, severe foot deformities, and
restricted fetal movements. The patient was gravida 3, para 2, with a history of
two previous cesarean deliveries.
A detailed ultrasonographic evaluation confirmed amelia,
bilateral femur shortening, and severe foot deformities. The family was
counseled regarding the prognosis, and pregnancy termination was offered. Upon
acceptance, the patient was admitted to the obstetrics and gynecology service
for termination. Routine blood tests and vital signs remained stable throughout
hospitalization.
Prior to medical treatment, intrauterine balloon catheter
placement with a Foley catheter was attempted to promote cervical ripening but
was unsuccessful. Medical termination was initiated with intravaginal
administration of 200 mcg misoprostol every 3 hours for five doses,
constituting one treatment cycle. The patient was regularly monitored via ultrasound
for signs of uterine rupture throughout the process. After four cycles, the
dosage was increased, and a modified regimen was introduced in the fifth cycle,
consisting of 400 mcg misoprostol (200 mcg intravaginally and 200 mcg
sublingually) every 3 hours for five doses.
Despite this regimen, pregnancy termination was not
achieved. After ruling out uterine rupture, intrauterine balloon placement was
reattempted and successfully performed. The Foley catheter remained in place
for 12 hours. After its removal, two additional cycles of 400 mcg misoprostol
were administered at regular intervals. Despite seven cycles of medical
termination, fetal expulsion was not achieved, necessitating a hysterotomy.
Postoperatively, the patient’s vital signs were stable
(heart rate: 127 bpm, blood pressure: 121/80 mmHg, temperature: 36.5°C, oxygen
saturation: 97%). However, she developed abdominal pain, vulvar swelling, and a
hematoma. Serial hemoglobin measurements showed a decline from 8.9 g/dL to 7.7
g/dL, prompting an upper abdominal and pelvic CT scan. The patient received two
units of packed red blood cells (PRBC) and fresh frozen plasma (FFP).
Imaging revealed uterine incision site dehiscence and an
11×6 cm hematoma anterior to the bladder, extending to the vulva. Additional
PRBC and FFP transfusions were administered due to persistent anemia (Hb: 7.9
g/dL). The patient was managed with antibiotics and local treatment for the
vulvar hematoma. No further hemoglobin decline was observed, and vital signs
remained stable throughout the follow-up period.
Keywords: Second-trimester termination, Hysterotomy, Medical
abortion failure, Vulvar hematoma,Uterine rupture risk