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
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Article info
Publication history
Published online: May 16, 2014
Accepted:
May 9,
2014
Received in revised form:
May 7,
2014
Received:
February 14,
2014
Footnotes
☆Financial support: The authors have no funding sources to report.
☆☆Disclosures: The authors have no potential conflicts of interests to disclose.
★The patient described in the case report has given written consent for the publication of this manuscript.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
