Uterine cavity perforation-obstetric and neonatal outcomes of subsequent pregnancies

Uterine perforation (UP) is a rare complication, most commonly occurring during dilatation and evacuation, intrauterine device (IUD) insertion, or hysteroscopy. While a history of UP may increase the risk of complications in future pregnancies, data on this association remains limited. The aim of the present study was to evaluate obstetric and neonatal outcomes in subsequent pregnancies following documented UP.

A retrospective cohort study of all patients with prior UP delivered between June 2011 to May 2022 was conducted at a single tertiary medical center. The patients were compared to a control group without a history of UP using propensity score matching (1:8 ratio). Primary outcomes were: (1) maternal composite adverse outcome including uterine rupture, placental abruption, postpartum hemorrhage (PPH), blood products transfusion, and hysterectomy and (2) neonatal composite adverse outcome including low Apgar score, low cord pH, need for mechanical ventilation, and neonatal intensive care unit (NICU) hospitalization. Secondary outcomes included specific maternal and neonatal adverse events.

The study group included 28 patients compared to 224 patients. There were no significant differences between the two groups in the composite maternal and neonatal outcomes. Two secondary outcomes-PPH and placenta accreta spectrum (PAS)-were significantly more common in the study group. One patient from the study group had a uterine rupture, and one patient underwent cesarean hysterectomy following a placenta percreta. These outcomes did not reach statistical significance.

A history of UP was not associated with composite maternal and neonatal complications. Higher rates of PPH and PAS were recorded in patients with prior UP.