Abstract
A 23-year-old G2P0020 presented with a large anterior subserosal hematoma after dilation and evacuation at 19 weeks in the setting of anterior cervical laceration during dilator placement. Owing to hemodynamic instability and brisk vaginal bleeding soon after presentation, she underwent diagnostic laparoscopy, which confirmed the large anterior subserosal hematoma and subsequently underwent bilateral uterine artery embolization. On POD 16, she presented again with brisk vaginal bleeding and had imaging concerning for a communication between the hematoma and uterine cavity, as well as hematoma superinfection. She underwent emergent exploratory laparotomy, which revealed copious old malodorous blood in the hematoma and necrotic uterine tissue with an underlying defect. The necrotic tissue was debrided and the uterine defect was repaired. Postoperative course was subsequently uncomplicated. This is an important lesson from both a trainee and faculty perspective, as hemorrhage into the subserosal space is a rare but potentially life-threatening complication of surgical abortion that should be considered when evaluating a patient postoperatively with hemodynamic instability.
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