Journal of Family & Community Medicine
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contact us Login 

Users Online: 354 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size


 Table of Contents 
Year : 2011  |  Volume : 18  |  Issue : 3  |  Page : 165-167  

An unusual complication of unsafe abortion

1 Department of Obstetrics and Gynecology, Subharti Institute of Medical Sciences, Uttar Pradesh, India
2 Department of Anesthesia, Subharti Institute of Medical Sciences, Uttar Pradesh, India
3 Department of Surgery, Subharti Institute of Medical Sciences, Uttar Pradesh, India

Date of Web Publication19-Nov-2011

Correspondence Address:
Sunita Gupta
Department of Obstetrics and Gynecology, Subharti Institute of Medical Sciences, Meerut Bypass Road, NH-54, Uttar Pradesh - 250 005
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2230-8229.90021

Rights and Permissions

Unsafe abortion is a significant medical and social problem worldwide. In developing countries, most of the unsafe abortions are performed by untrained personnel leading to high mortality and morbidity. Case Report: A 30 year-old female, gravida 7, para 6 underwent uterine evacuation for heavy bleeding per vaginum following intake of abortifacient to abort a 14 weeks gestation. The procedure was performed at a rural setup and her bowel was pulled out of the introitus through the perforated wound, an unusual complication of unsafe abortion. Illiteracy, unawareness about health services, and easy accessibility to untrained abortion providers lead to very high mortality and morbidity in India. There is unmet need to bring awareness among the people about the safe and effective methods of contraception and abortion services to avoid such complications.

Keywords: Unsafe abortion, uterine evacuation, uterine perforation

How to cite this article:
Gupta S, Chauhan H, Goel G, Mishra S. An unusual complication of unsafe abortion. J Fam Community Med 2011;18:165-7

How to cite this URL:
Gupta S, Chauhan H, Goel G, Mishra S. An unusual complication of unsafe abortion. J Fam Community Med [serial online] 2011 [cited 2022 Jan 20];18:165-7. Available from:

   Introduction Top

Unsafe abortion is a significant medical and social problem worldwide. According to World Health Organization, a woman dies every eighth minute in developing nation due to complications arising from unsafe abortion. [1] Each year 42 million abortions are estimated to take place, 22 million safely and 20 million unsafely. Unsafe abortion accounts for 70,000 maternal deaths each year and causes a further 5 million women to suffer temporary or permanent disability. [2] Approximately 1 in 10 pregnancies end in unsafe abortion, giving a ratio of 1 unsafe abortion to about 7 live births. [3] Most of the unsafe abortions are performed in developing countries. In western nations, only 3% of abortions are unsafe, whereas in developing nations 5% are unsafe. Highest incidences of unsafe abortions take place in Latin America, Africa, and South East Asia. [1] A survey of 2400 women in Madhya Pradesh, India, found that 32% of women aged 35-39 years had attempted abortion at some time, and 23% had an abortion, indicating that roughly one in four women who attempted abortion did not succeed. Self induced morbidity was higher in rural areas (57%) than in urban areas (45%). Severe complications were also more common in rural areas (35% versus 16%), showing that higher risks are associated with abortions in underserved rural areas. Not unexpectedly, only 9% of the women knew that abortion was legal, 49% thought that abortion was illegal, and 36% did not know its legal status; the remaining 6% reported knowing that abortion was legal, but their knowledge of the period within which it was legal was incorrect. [4] The main causes of mortality or morbidity due to unsafe abortion are hemorrhage, sepsis, genital trauma, and bowel injury. Here we are presenting a case report of an unusual complication of unsafe abortion where bowel is pulled out of the vaginal introitus through uterine perforation [Figure 1].
Figure 1: Congested and edematous intestinal loops pulled out of vaginal introitus

Click here to view

   Case Report Top

A 30 year-old female was admitted with complaints of pain abdomen and something coming out per vaginum since 2 hours following evacuation of the uterus done for an incomplete abortion following 3 months amenorrhoea. She was a gravida 7 para 6 and had taken an abortifacient 15 days before the day of admission to abort an unintended 14 weeks gestation. She had continuous bleeding per vaginum following that, for which she underwent uterine evacuation at a rural hospital. She developed acute pain abdomen and felt something at vaginal introitus following the procedure. She was brought to our hospital for further management. On examination, she was conscious but irritable and the pulse rate was 146/min, blood pressure 80/50 mm Hg, and temperature was 100° F. On abdominal examination, there was a vertical paramedian incision of previous caesarean section present. Abdomen was tense and tender. Bowel sounds were absent. On local examination, congested and edematous intestinal loops were seen outside the vaginal introitus. Per speculum and per vaginum examination was not possible because of the bowel loops obstructing the introitus tightly. Her investigations revealed hemoglobin 7.5 gm/dl, white blood cell count 28,690/-ml, platelet count 3,91,000/ml, blood sugar 100 mg/dl, and serum creatinine 0.9 mg/dl.

A clinical diagnosis of uterine perforation with shock was made, and her exploratory laparotomy was performed after resuscitation. Peroperatively, the perforation was present in the fundal region [Figure 2] of the uterus, and about 3 feet of small intestine was pulled out through it, which was gangrenous [Figure 3]. The mesenteric vessels supplying the segment were ligated and resected. The gangrenous intestinal segment was resected close to the perforation and an end to end jejunoileal anastomosis was done. The gangrenous intestinal segment was removed through the vagina and primary repair of the uterine perforation was done. Postoperatively she was kept on ventilator support for 2 days and three units of packed red blood cells, broad-spectrum antibiotics, and intravenous fluid were given. She responded well to the treatment and was discharged on the 14 th postoperative day.
Figure 2: Laparotomy showing perforation in uterine fundus

Click here to view
Figure 3: Specimen showing resected gangrenous intestinal segment

Click here to view

   Discussion Top

The patient was multigravida and she wanted to terminate her unintended pregnancy for which she took some medicine herself. This results in incomplete abortion and she developed heavy bleeding per vaginum. She was brought to a rural setup nearby her village, where uterine evacuation was done which results not only perforation of the uterus but her intestine was also pulled through it out of the introitus leading to severe morbidity. In various studies, about 55-77% of abortions were carried out by untrained and unqualified people. [5],[6],[7] These unqualified abortion providers are easily accessible to the clients in countries such as India. Illiteracy, unawareness about the available health facilities, hesitations and myths about contraception use, over the counter availability of the drugs for medical abortion, and easy accessibility to untrained abortion providers lead to very high mortality and morbidity in India. Complication due to unsafe abortion accounts for an estimated 13% of maternal deaths worldwide or 70,000 deaths per year. [8] Although bowel perforation is a well-known complication of unsafe abortion, pulling of bowel upto the introitus is an unusual complication of unsafe abortion.

   Conclusions Top

In spite of legalization of abortion in India in 1971, most of the abortions are done by untrained personnel. Factors inhibiting use of safe abortion where it is legal are lack of privacy and confidentiality, poor access, and discouraging attitudes of healthcare providers. Therefore, only legalization of abortion is not sufficient to reduce the number of unsafe abortions. There is unmet need to bring awareness among the people about the safe and effective methods of contraception and abortion services so that such types of complication can be prevented.

   References Top

1.World Health Organization. Unsafe abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2003. 5 th ed. Geneva: World Health Organization; 2007.  Back to cited text no. 1
2.Shah I, Ahman E. Unsafe abortion: Global and regional incidence, trends, consequences, and challenges. J Obstet Gynaecol Can 2009;31:1149-58.  Back to cited text no. 2
3.World Health Organization. Unsafe abortion: Global and regional estimates of incidence of unsafe abortion and associated mortality in 2000. 4th ed. Geneva: World Health Organization; 2004.  Back to cited text no. 3
4.Malhotra A, Nyblade L, Parasuraman S, MacQuarrie K, Kashyap N. Realizing reproductive choice and rights: Abortion and contraception in India. Washington, DC: International Center for Research on Women (ICRW); 2003.  Back to cited text no. 4
5.Jain V, Saha SC, Bagga R, Gopalan S. Unsafe abortion a neglected tragedy. Review from a tertiary care hospital in India. J Obstet Gynaecol 2004;30:197-201.  Back to cited text no. 5
6.Naib JM, Siddhiqui MI, Afridi B. A review of septic induced abortion cases in one year at Khyber teaching hospital, peshwar. J Ayub Med Coll Abbottabad 2004;16:59-62.  Back to cited text no. 6
7.Bhattacharya S, Mukherjee G, Mistri P, Pati S. Safe abortion- still a neglected scenario: A study of septic abortions in a tertiary hospital of rural India. Online J Health Allied Sc 2010;9:7.  Back to cited text no. 7
8.Singh S, Wulf D, Hussain R, Bankole A, Sedgh G. Abortion Worldwide. A decade of Uneven Progress. New York: Guttmacher Institute; 2009  Back to cited text no. 8


  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Specific small bowel injuries due to prolapse through vaginal introitus after transvaginal instrumental gravid uterus perforation: a review
Goran Augustin,Davor Mijatovic,Bozidar Zupancic,Dragan Soldo,Mario Kordic
Journal of Obstetrics and Gynaecology. 2019; : 1
[Pubmed] | [DOI]
2 Reproductive Rights and Informed Consent: Toward a More Inclusive Discourse
Debra Mollen
Analyses of Social Issues and Public Policy. 2013; : n/a
[Pubmed] | [DOI]
3 The horror of unsafe abortion: case report of a life threatening complication in a 29-year old woman
Kaniz Naqvi,Muhammad Edhi
Patient Safety in Surgery. 2013; 7(1): 33
[Pubmed] | [DOI]
4 Uterine perforation as a complication of surgical abortion causing small bowel obstruction: a review
Goran Augustin,Mate Majerovic,Tomislav Luetic
Archives of Gynecology and Obstetrics. 2013; 288(2): 311
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
   Case Report
    Article Figures

 Article Access Statistics
    PDF Downloaded460    
    Comments [Add]    
    Cited by others 4    

Recommend this journal

Advertise | Sitemap | What's New | Feedback | Disclaimer
Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010