1 An Unusual Complication at Medical Termination of Pregnancy (M.T.P.) (14 feet of intestinal injury) 2 Presented By Dr.Narayan M.Patel M.D.D.G.O. FICS Mahalaxmi Institute of medical teaching 3 Shantiniketan park Naranpura Nr.Sardar Patel Colony AHMEDABAD- 380 014 (Gujarat) INDIA T.N.(079) 27682572 E mail- narayanpatel1932_at_yahoo.com 3 M.T.P. was attempted by an unqualified general practitioner to terminate 16 weeks of pregnancy in a middle-aged patient in the city of Ahmedabad (Gujarat state) INDIA 4 Not knowing what he is pulling out ultimately got frightened and he came with the patient to a general hospital at 10 oclock night. 5 Patient was resuscitated. Gynecologist asked help from surgical team. Laparotomy was performed. Thisshows loops of intestine coming out of vulva and lying in a kidney tray in operation theater Pt. was in a state of shock. 6 Patient was in a state of shock Same as previous at a little close up view. Loops of intestine are in kidney tray. 7 Patient was in shock with about 8 to 10 feet of intestine hanging out of vagina on admission. 8 Gynecologist performed laparotomy immediatey and help from surgical team was asked for. At laparotomy there was a big perforation at the fundus of uterus and a loops of intestine were seen passing through it and into vagina and out of vulva. This is shown in followings. 9 showing a loop of intestine coming out a perforation in anterior wall of uterus. The loop of intestine on left side has change in colour. 10 Same as previousat a little close up view. Bulky Ut. is seen. Loops of intestine were cut after application of intestinal clamps. Hanging intestine were pulled out of vulva. Remaining products of conception were evacuated from uterus Uterine perforation was sutured with vicryl. 11 The case was handed over to surgical team. The damaged intestine were resected by the surgical team and end to end anatomists of intestine was performed. Pt. was given 3 transfusions and higher antibiotic cover. 12 Conclusion Thisshows resection and anestomosis of intestine being performed by surgical team 13 showing loops of intestine and mesentry arranged in row on table by a resident. 14 Total length of intestine and mesentery was about 14 feet. You see a resident measuring it. 15 The patient had a stormy convalescent but she survived the surgery. 16 We talk a lot about safe mother hood but how much safer is safe-motherhood even in year 2004 (Year in which this happened) in city like Ahmedabad (Gujarat state-INDIA) What will be the condition in villages 17 The unqualified doctor who did this complication escaped unharmed. We still need to popularize through media and encourage people not to get treatment from unqualified persons and take treatment from government hospital where M.T.P. (Medical termination of pregnancy) is being performed free of cost by qualified doctors and is more safe. 18 THANK YOU
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