Birth following perforation of uterus during D&C

[CaptainWentworth]

Hi all,

I’ve not been able to find much online about my situation (and what there is seems to be mostly from the US so not necessarily that applicable to how things are done here) so hoping someone on here might have experience.

I had a MMC at 10 weeks with my first pregnancy a couple of years ago and had surgical management, which unfortunately resulted in perforation of my uterus. At the time I was told it would heal well and shouldn’t affect future pregnancies, although to be honest I was quite wobbly afterwards with the GA and everything so I can’t remember exactly what was said- it was definitely not flagged as a high risk in future though.

I’m now 16 weeks pregnant, and was booked for a consultant appointment at the same time as my first scan, to discuss any implications- I’d mentioned it to my midwife at booking in but she couldn’t tell me anything and so referred me to consultant. I’d been led to believe I’d be low risk as I’m not overweight and don’t have any health problems, so I was kind of shocked when the consultant started talking about the risks associated with the perforation.

I’d assumed I’d not be at any higher risk than someone who’d had a previous CS, but she said that the perforation was probably higher up than a CS scar which made it more likely to rupture in labour (thicker muscle) and also there was a risk of placenta accreta due to the placenta attaching to the scar tissue, which would make it harder to remove and worst case scenario could be hysterectomy! My options would be ELCS or birth with continuous monitoring with EMCS in case of any problem at all- depending on where scar and placenta are.

I have my 20 week scan booked with a specialist who should be able to see more about where the scar and the placenta are, and they will do an MRI if they can’t see enough by ultrasound.

I can’t do or find out much more until I have the scan, but has anyone here ever been in a similar situation? There is a lot of info around about VBAC but this seems to be different.

I’m feeling disappointed that I may never be able to experience a ‘normal’ birth due to an error that wasn’t my fault, and also worried by all the mentions of rupture and possible catastrophic bleeding.

I don't know if this is any help at all as I haven't been through something similar. But I have been mulling my options regarding VBAC vs CS, and think I am veering towards CS after my dr put the wobblies up me regarding a VBAC and uterine rupture (basically, she had a patient who ruptured, and then I know someone personally who ruptured). I went for a second opinion, and was told that one of the risk factors for rupture was previously-undisclosed history, such as a D&C that damaged the uterus (as yours clearly did). So I guess all I'm trying to say is that the dr mentioned it as a risk factor for rupture. But I live abroad, and they err more on the side of caution here.

I had a perfortated uterus from a merina coil, I'm not sure if it would be the same as not sure how big your perforation was, but mine was right at the top of my uterus and it had to be cut out as it was shoved through the muscle when it was fitted 11 months previously. I've had 2 babies since, one a homebirth and I'm 35 weeks pregnant and booked for another homebirth. Nothing has ever been mentioned about it putting me at higher risk

Thanks both for the replies.

Rikalaily that’s really interesting- I understand that perforations from IUDs tend to be smaller as the devices themselves are ‘thinner’ (for want of a better description) than the device used to empty the uterus- but if you had to have it cut out that sounds like quite a big wound!

And yeah redrum29 rupture is a scary word! DH is a GP and he got really worried when that was mentioned too. If it’s a really small chance then I might be ok with that, but the consultant was talking like it was a real possibility.

I guess they just don’t really know with me yet- they might downgrade the risk rating after the scan perhaps if they can see it’s a small scar?

I realise this post is old but I have had a similar experience after my second miscarriage. I have a perforation following MVA, and just trying to get through this by focusing on the future. I hope all went well with your pregnancy, but just wondering what your outcome was/how they looked after your pregnancy?

@CaptainWentworth

I realise this post is old but I have had a similar experience after my second miscarriage. I have a perforation following MVA, and just trying to get through this by focusing on the future. I hope all went well with your pregnancy, but just wondering what your outcome was/how they looked after your pregnancy?

Hi @Carott1234 - gosh I’d completely forgotten I posted about this on here! Sorry to hear of your experience- hope you are recovering ok.

My memory is a bit rubbish to be honest so I won’t be able to remember all the details, but I went for my 20 week scan with the fetal medicine consultant not long after this. He was obviously very experienced, but so quick that we had to sit down with ‘his’ nurse afterwards to get a debrief! Also no scan photos which was a bit annoying. Anyway we did manage to pin his opinion down which was basically that he wasn’t quite sure why I’d needed to see him and he couldn’t even see a scar at all, therefore he couldn’t see why there would be any increased risk.

I had an appointment with the obstetric consultant again after this, and she was still wanting to err on the side of caution - so I basically had 2 opposing opinions to deal with. However given that the fetal medicine guy had written that there was no issue, and he was more experienced in this area, she agreed that I could be classed as low risk- the main thing was that I wanted to be able to give birth in the midwife led unit in Newcastle, rather than on the labour ward- however the MLU is in the same building as the labour ward so it’s really easy to transfer in case of an issue, so i felt this was a low risk plan really.

When I did go into labour and called the unit, I mentioned my history and they went off and fetched one of their most experienced midwives to speak to me, and I think it was her that ended up looking after me when I did go in. Anyway it all went fine, I was able to use the pool which I wanted, and while I did end up having to go upstairs for a ventouse delivery, this had nothing to do with the perforation.

I’m now pregnant again and have only had my booking in appointment so far. The midwife has referred me to the consultant again for the perforation so no doubt I’ll have to go through the same process again to get onto the MLU (depending on who I end up seeing) but we shall see!

Hope that is useful and don’t hesitate to ask me anything else. It’s a shame there is so little information out there about this issue- everyone I spoke to said it was very rare and seemed to have little experience of it (except the fetal medicine guy who basically said it’s not an issue - I wish he would tell his colleagues that!) but I can’t imagine it’s really quite as rare as all that.

Best wishes anyway x

Thank you so so much for your response! The past four weeks have been awful, and as much as the pain and bleeding is getting me down, the thought of future pregnancies and my risk is upsetting me more. So that is so reassuring to hear that yours went all so well and there were no concerns by the experts. I’ve gathered a few people’s opinions so far and they all seem to differ also- some feeling I would need to labour very carefully, others believing that I will heal well. No one has a consensus on when I should try again and this would be safe. I basically had to beg to be seen again after the surgical procedure- it was under local and my blood pressure was in the 70s just after, I had been unconscious and had vomited with the pain, with everyone telling me I was okay (and me just thinking this must be normal), and just a bit faint and my husband essentially carrying me out. And they didn’t even take my cannula out. I was in so much pain and bleeding after heavily so I called back but it took till 3 days later when they would see me and then diagnosed that the pain I experienced must have been them perforating my womb. I still feel traumatised and shocked by it all. I went back the following week and they can no longer find the hole, but I think the sonographer was just inexperienced, so going to see the consultant hopefully tomorrow. I’m bleeding heavily again after a small break, and have only just got my negative pregnancy test, so maybe this is my period?

I’m so sorry to ramble on, but besides from my husband and these doctors that I don’t hugely trust anymore, I don’t really feel I can talk to anyone about this and them understand the worry I have. I’m so glad everything worked out well with you and that you are pregnant again! That’s so amazing! All I want is a little family, but given 2 miscarriages and now my complications I’m really starting to doubt.

It seems you were looked after really well on the NHS, with your consultant at least getting a second opinion etc. Did you ever consider going private or did you feel well supported? Given my experience, I’m unsure if I would trust my local unit to do that.

Once again sorry for rambling on, I hope all goes well and thank you for your response. X

I’ve been meaning to reply all day but only jus got a chance to do so properly - I’m so sorry you had such a dreadful experience with the surgery; that sounds very scary. I think you should consider complaining once you feel able to - at least contact PALS as it sounds like they really didn’t look after you properly.

It was totally different for me in that I was under general anaesthetic and the surgeon realised what he had done straight away, so he went in laparoscopically and put a couple of stitches in while I was still under, then told me what had happened (very sheepishly!) when I was back on the ward. I was told it shouldn’t be a problem in the future which is why I was so surprised by the obstetrician’s reaction initially.

Interestingly, I found out afterwards (I can’t remember if I read it somewhere or if another doctor or midwife told me), that usually they don’t bother stitching the wound when there’s a perforation like I had as the uterus has such a good blood supply that a small wound heals very easily on its own. It’s definitely plausible I think that there might not be anything to see on a scan, but I hope the consultant can offer a more expert opinion or refer you to someone else who can (is it a gynaecologist you’re seeing?)

But as you say there seems to be this weird divide between some doctors who say it heals well, shouldn’t cause an issue, and others who think it’s a huge risk. The ‘labour very carefully’ message was essentially what I heard from the obstetrician when I first discussed it with her. I wonder if obstetricians are just very very risk averse because they do sometimes see really devastating outcomes from birth complications- from all causes. It was quite off putting though, feeling that the only way I could make a decision on whether I needed a section or not was to try and gauge the different doctors’ attitudes to risk!

The bottom line though is that I don’t think there’s any reason why this should stop you having a good pregnancy and birth and a healthy baby in the future- even if there are issues they can be managed. You’re still recovering from the miscarriage too right now and that’s hard on it’s own without these other worries.

Sorry - just one more thought (I am rambling here too!) - I think I was/am very lucky because the RVI in Newcastle is a massive teaching hospital with lots of specialists on site (in fact I know someone who applied for a job as a specialist registrar in fetal medicine there, as it’s one of the top centres in the UK). I don’t know which hospital you’re under, but if they don’t have the specialists it might be worth pushing to be referred somewhere else for an opinion once you are pregnant again (I don’t know how easy this is though).

Unfortunately I’m not sure if the doctors will be able to do a lot more until you’re in that position- I had to wait until the 20 week scan for them to have a chance of seeing what was going on as it’s too hard to see the scar or where it will end up on the uterus until it’s stretched a bit (I was told).