Advertisement

Controversies in family planning: pregnancy termination in women with uterine anatomic abnormalities

      A 35-year-old G3P2002 woman presented to our clinic for elective termination of her first trimester pregnancy. She had a history of one prior uncomplicated vaginal delivery at term, followed by an uncomplicated cesarean delivery at term for breech. Initial transvaginal ultrasound showed a single intrauterine pregnancy with a crown-rump length of 0.38 cm consistent with 6 weeks 1 day gestational age. The resident started the dilation but with some difficulty. The fellow took over and was able to adequately dilate and pass the 7-mm cannula but then noted no tissue return with the manual vacuum aspirator (MVA). The attending then performed transabdominal ultrasound guidance which showed that the cannula did not appear to be in the same cavity as the pregnancy; however, it did not appear extrauterine. We removed all instruments and performed a transvaginal ultrasound which showed two uterine cavities, with a thin endometrial stripe on the right and the intrauterine pregnancy on the left. At this point, the speculum was replaced, a second sterile prep was done and the attending attempted unsuccessfully to pass instruments into the left cavity under ultrasound guidance. We decided to proceed with a medication abortion using mifepristone and misoprostol. Two days later, the patient called the clinic reporting that after taking the misoprostol she had cramping but no bleeding. Our team is planning to repeat the misoprostol. Any additional thoughts if this attempt is still not successful?

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Raymond E.G.
        • Grimes D.A.
        The comparative safety of legal induced abortion and childbirth in the United States.
        Obstet Gynecol. 2012; 119 ([Epub 2012/01/25]): 215-219
        • Bruce F.C.
        • Berg C.J.
        • Hornbrook M.C.
        • Whitlock E.P.
        • Callaghan W.M.
        • Bachman D.J.
        • et al.
        Maternal morbidity rates in a managed care population.
        Obstet Gynecol. 2008; 111 ([Epub 2008/05/02]): 1089-1095
        • Paul M.
        • Lackie E.
        • Mitchell C.
        • Rogers A.
        • Fox M.
        Is pathology examination useful after early surgical abortion?.
        Obstet Gynecol. 2002; 99 ([Epub 2002/06/01]): 567-571
        • Kaunitz A.M.
        • Rovira E.Z.
        • Grimes D.A.
        • Schulz K.F.
        Abortions that fail.
        Obstet Gynecol. 1985; 66 ([Epub 1985/10/01]): 533-537
        • Fielding W.L.
        • Lee S.Y.
        • Friedman E.A.
        Continued pregnancy after failed first trimester abortion.
        Obstet Gynecol. 1978; 52 ([Epub 1978/07/01]): 56-58
        • Valle R.F.
        • Sabbagha R.E.
        Management of first trimester pregnancy termination failures.
        Obstet Gynecol. 1980; 55 ([Epub 1980/05/01]): 625-629
        • Nahum G.G.
        Uterine anomalies. How common are they, and what is their distribution among subtypes?.
        J Reprod Med. 1998; 43: 877-887
      1. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions.
        Fertil Steril. 1988; 49 ([Epub 1988/06/01]): 944-955
        • Buttram Jr., V.C.
        • Gibbons W.E.
        Mullerian anomalies: a proposed classification. (An analysis of 144 cases).
        Fertil Steril. 1979; 32 ([Epub 1979/07/01]): 40-46
        • Pui M.H.
        Imaging diagnosis of congenital uterine malformation.
        Comput Med Imaging Graph. 2004; 28 ([Epub 2004/10/07]): 425-433
        • Kriplani A.
        • Relan S.
        • Mittal S.
        • Buckshee K.
        Pre-rupture diagnosis and management of rudimentary horn pregnancy in the first trimester.
        Eur J Obstet Gynecol Reprod Biol. 1995; 58 ([Epub 1995/02/01]): 203-205
        • Hall-Craggs M.A.
        • Kirkham A.
        • Creighton S.M.
        Renal and urological abnormalities occurring with Mullerian anomalies.
        J Pediatr Urol. 2013; 9 ([Epub 2011/12/02]): 27-32
        • Oppelt P.
        • von Have M.
        • Paulsen M.
        • Strissel P.L.
        • Strick R.
        • Brucker S.
        • et al.
        Female genital malformations and their associated abnormalities.
        Fertil Steril. 2007; 87 ([Epub 2006/11/28]): 335-342
        • Cutner A.
        • Saridogan E.
        • Hart R.
        • Pandya P.
        • Creighton S.
        Laparoscopic management of pregnancies occurring in non-communicating accessory uterine horns.
        Eur J Obstet Gynecol Reprod Biol. 2004; 113 ([Epub 2004/03/24]): 106-109
        • Edelman A.B.
        • Jensen J.T.
        • Lee D.M.
        • Nichols M.D.
        Successful medical abortion of a pregnancy within a noncommunicating rudimentary uterine horn.
        Am J Obstet Gynecol. 2003; 189 ([Epub 2003/10/04]): 886-887
        • Park J.K.
        • Dominguez C.E.
        Combined medical and surgical management of rudimentary uterine horn pregnancy.
        JSLS. 2007; 11 ([Epub 2007/07/27]): 119-122
        • Jayasinghe Y.
        • Rane A.
        • Stalewski H.
        • Grover S.
        The presentation and early diagnosis of the rudimentary uterine horn.
        Obstet Gynecol. 2005; 105 ([Epub 2005/06/04]): 1456-1467
        • Reichman D.
        • Laufer M.R.
        • Robinson B.K.
        Pregnancy outcomes in unicornuate uteri: a review.
        Fertil Steril. 2009; 91 ([Epub 2008/04/29]): 1886-1894
        • Nahum G.G.
        Rudimentary uterine horn pregnancy. The 20th-century worldwide experience of 588 cases.
        J Reprod Med. 2002; 47: 151-163
        • Heinonen P.K.
        Unicornuate uterus and rudimentary horn.
        Fertil Steril. 1997; 68 ([Epub 1997/08/01]): 224-230