Transfundal hysterotomy after an unsuccessful dilation and evacuation procedure due to uterine fibroids

A woman in her 20s, at 13 weeks gestation, presented to the emergency department (ED) for escalation of care after an incomplete second trimester termination. Imaging in the ED revealed multiple uterine fibroids up to 10 cm. She was admitted to Obstetrics and Gynaecology for completion of the evacuation via dilation and curettage; however, this could not be completed, as multiple fibroids were preventing visualisation and access to the cervical canal. Evacuation was successfully completed via mini-laparotomy and hysterotomy. The patient had no postoperative complications and was discharged 2 days later. This case illustrates a rare cause of unsuccessful abortion due to interfering fibroids and outlines hysterotomy as an effective secondary evacuation strategy for complicated second trimester abortions, particularly when products of conception are still present.