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A 21-year-old unmarried female, residing in a village in North India, secretly indulged in an illegal abortion at 18 weeks of gestation by consuming abortion pills that she had procured from a local pharmacy. Since the fetus was not expelled, she visited a village midwife the next day, who delivered the baby by instrumentation. Few hours later, she had bouts of cough that led to prolapse of intestine from the vagina.

While unsafe abortion is a preventable cause of maternal mortality, it continues to be a public health challenge, accounting for 13% of pregnancy-related mortality worldwide. Worst complications are faced by women of low socioeconomic status residing in countries with restrictive abortion laws.

Uterine rupture is said to occur when there is a breach of all the three layers (endometrium, myometrium, and perimetrium). It has classically been described as a complication occurring in women who have previously undergone a cesarean section, particularly those undertaking vaginal birth after a cesarean section. The other causes of uterine rupture are road traffic accidents, instrumentation, and obstetric maneuvers.

1.(A) Part of small bowel that had prolapsed from vagina. (B) The site of entry into the uterus (arrow) seen after laparotomy.

2.(A) The prolapsed bowel that was pulled back through the uterine defect was gangrenous and detached from mesentery. (B) Resection was done at the junction of gangrenous and viable bowel.

3.(A) The defect seen on the posterior wall (arrow) of uterus. (B) Jejunal stoma seen post-operatively.



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