Role of Laparoscopy in Management of Post Abortion Haemorrhage – Case Reports

Introduction Hemorrhage is the most common cause of abortion-related mortality , accounting for 30-40% deaths following abortion. Post abortion hemorrhage includes bleeding in excess usually > 500ml and /or requirement of admission or transfusions. [1] Although hemorrhage after abortion is rare, it is associated with significant morbidity and mortality. Prior cesarean sections place women at higher risk of overall complications from second-trimester abortion, with one study demonstrating odds of complications seven times as great among women with two or more cesarean sections as among those with none [2] Here by we present two cases of complications after attempted first trimester termination, managed laparoscopically. Because of the well known advantages of the laparoscopic approach compared with laparotomy only for gynaecological diseases, we report 2 cases of post abortal complications. The role of laparoscopy in minimally invasive management and preserving the uterus for future fertility is focused through these case reports. Case reports Case 1 A 22 year old female P1L1A1 with one previous lower segment caesarean section (LSCS) , missed abortion, had suction evacuation a month before presented to us with a history of heavy bleeding per vaginum with clots ever since the evacuation. At the time of presentation, she was severe anaemic with haemoglobin of 4.5g/dl despite three units packed red blood cell (PRBC) transfusion after evacuation. Ultrasonography showed an abnormal appearing uterine contour with intramural solid lesion of 3.6x3.6 cm with ill-defined margins at the level of body and cervix of uterus , peri-capsular high resistance flow and a few cystic areas in lumen.