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Severe lacerations of the uterus following a criminal abortion
SEVERE
LACERATIONS OF THE UTERUS A CRIMINAL ABORTION”
JOHN R. WOLFF, (From
M.D., AND MARVIN
the Department
of Obstetrics University
FOLLOWING
A. ROSNER, M.D., CHICAGO, ILL. College of I!&edicine,
and Gynecology, of Illinois)
JUNE 5, 1953, at 9 :30 a young woman was brought into the Henrotin 0doctorNHospital emergency room in a wheel chair. She was accompanied by a who gave the following information : P.M.
The patient was first seen by him at 2:30 P.M. on June 4, thirty hours prior to admission to our hospital. During her stay at his office, about thirty hours, he gave her 2 pints of whole blood and 1 pint of plasma. The patient was a 28-year-old nulliparous, single white woman who clinically appeared very ill. Her last menstrual period was March 27, 1953, 10 weeks prior to admission. She was semicomatose, the blood pressure was 150/90, pulse 120, respirations 32, temperature 100.4” F., with a markedly distended abdomen and a small amount of bright vaginal bleeding. No bowel sounds were heard and there was evidence of fluid in the abdominal cavity. Bimanual palpation revealed a soft, patulous cervix which admitted a fingertip and fullness in the cul-de-sac, but the corpus was not palpable because of the abdominal distention. With the speculum inserted, a small amount of bright and dark blood was noted coming from the cervical OS and there were several small recent lacerations on the anterior cervical lip similar to those made with a tenaculum.
Fig.
L.-The
black
area
shows
the
area of rupture, extending to the right cornu.
from
the
left
uterine
artery
We felt that it was either a ruptured ectopic pregnancy or a criminal abortion with intra-abdominal hemorrhage. She was taken to the operating room and a colpopuncture was done, with dark blood withdrawn in the syringe. A midline subumbilical incision was made, and as soon as the peritoneum was open, approximately 1,500 to 2,000 C.C. of blood gushed out or was suctioned out from the cavity. The uterus was literally torn for a distance of 8 to 10 cm. from the right horn along thr fundus around the left horn to the level of the left cervical vessel. The left tube and ovary were absent. The right tube and ovary were normal. *Presented
at a meeting
of the
Chicago
Gynecological 191
Society,
Dec.
18, 1953.
The cervix with rrtbf I‘<' Due to the extent of the tear a hysterectonly was done. ‘I’llt~ tjtj\yf~] w:ls t::~rt:fully t~samille~l I’<)! moved because of the patient’s ~,oor condition. lacerations, but none were found. The atrdom~w was ~~lostv I. Her immediate postoperative condition IV:W f’:tir. ‘I’ho l~l0td 1brwsuw was llUj’7~l. IPU~W 134, respiration 20. By this timo shy had rt~irc~l 1,000 ~3.r. of wholr blood and intravenous fluid therapy was continued. Streptomycin, 0.5 Urn., and procaine penicillin, 400,000 units were given every six hours. The following morningz with no oral nourishment tolrral(~~I 28 iut ravenous Trrrarnycin was civrrl and a fever of 101’ F., pulse 136, and respiration (1.0 Gm. daily). The evening of the first postopera;ive day the patient was ~stllpclrtHlr. temperature 104” F., pulse 120, with labored respirations resembling the Clir~yne-Stokes variety, and the paralytic Zeus was still present. At this time, because of her very crit,ica.l condition, 25 units of ;1CTH was given an<1 continued at six-hour intervals. The hospital course from here on was one of gradual improvement, the ileus disapprarkg on the second postoperative day the patient becoming afebrilc hy the fourth postoperativt, day. She was discharged in good condition on the eleventh postoperative day. The follou up examinations have shown her to be in excellent condition.
Summary A case is presented of :I, se\:erely Ia(~rmt.etl uterus abortion with unusual preatlmission CilvllmstanCes. 30
NORTH
MICHIGAN
AVENUE
following
a crimim~l
LACERATIONS OF THE UTERUS A CRIMINAL ABORTION”
JOHN R. WOLFF, (From
M.D., AND MARVIN
the Department
of Obstetrics University
FOLLOWING
A. ROSNER, M.D., CHICAGO, ILL. College of I!&edicine,
and Gynecology, of Illinois)
JUNE 5, 1953, at 9 :30 a young woman was brought into the Henrotin 0doctorNHospital emergency room in a wheel chair. She was accompanied by a who gave the following information : P.M.
The patient was first seen by him at 2:30 P.M. on June 4, thirty hours prior to admission to our hospital. During her stay at his office, about thirty hours, he gave her 2 pints of whole blood and 1 pint of plasma. The patient was a 28-year-old nulliparous, single white woman who clinically appeared very ill. Her last menstrual period was March 27, 1953, 10 weeks prior to admission. She was semicomatose, the blood pressure was 150/90, pulse 120, respirations 32, temperature 100.4” F., with a markedly distended abdomen and a small amount of bright vaginal bleeding. No bowel sounds were heard and there was evidence of fluid in the abdominal cavity. Bimanual palpation revealed a soft, patulous cervix which admitted a fingertip and fullness in the cul-de-sac, but the corpus was not palpable because of the abdominal distention. With the speculum inserted, a small amount of bright and dark blood was noted coming from the cervical OS and there were several small recent lacerations on the anterior cervical lip similar to those made with a tenaculum.
Fig.
L.-The
black
area
shows
the
area of rupture, extending to the right cornu.
from
the
left
uterine
artery
We felt that it was either a ruptured ectopic pregnancy or a criminal abortion with intra-abdominal hemorrhage. She was taken to the operating room and a colpopuncture was done, with dark blood withdrawn in the syringe. A midline subumbilical incision was made, and as soon as the peritoneum was open, approximately 1,500 to 2,000 C.C. of blood gushed out or was suctioned out from the cavity. The uterus was literally torn for a distance of 8 to 10 cm. from the right horn along thr fundus around the left horn to the level of the left cervical vessel. The left tube and ovary were absent. The right tube and ovary were normal. *Presented
at a meeting
of the
Chicago
Gynecological 191
Society,
Dec.
18, 1953.
The cervix with rrtbf I‘<' Due to the extent of the tear a hysterectonly was done. ‘I’llt~ tjtj\yf~] w:ls t::~rt:fully t~samille~l I’<)! moved because of the patient’s ~,oor condition. lacerations, but none were found. The atrdom~w was ~~lostv I. Her immediate postoperative condition IV:W f’:tir. ‘I’ho l~l0td 1brwsuw was llUj’7~l. IPU~W 134, respiration 20. By this timo shy had rt~irc~l 1,000 ~3.r. of wholr blood and intravenous fluid therapy was continued. Streptomycin, 0.5 Urn., and procaine penicillin, 400,000 units were given every six hours. The following morningz with no oral nourishment tolrral(~~I 28 iut ravenous Trrrarnycin was civrrl and a fever of 101’ F., pulse 136, and respiration (1.0 Gm. daily). The evening of the first postopera;ive day the patient was ~stllpclrtHlr. temperature 104” F., pulse 120, with labored respirations resembling the Clir~yne-Stokes variety, and the paralytic Zeus was still present. At this time, because of her very crit,ica.l condition, 25 units of ;1CTH was given an<1 continued at six-hour intervals. The hospital course from here on was one of gradual improvement, the ileus disapprarkg on the second postoperative day the patient becoming afebrilc hy the fourth postoperativt, day. She was discharged in good condition on the eleventh postoperative day. The follou up examinations have shown her to be in excellent condition.
Summary A case is presented of :I, se\:erely Ia(~rmt.etl uterus abortion with unusual preatlmission CilvllmstanCes. 30
NORTH
MICHIGAN
AVENUE
following
a crimim~l