Failed dilatation and evacuation due to false passage in a case of retained products of conception following self-medication abortion: a case report

Abstract

Self-medication with medical termination of pregnancy (MTP) pills without supervision is a common practice in developing countries specially in India and can lead to significant complications. We report a case of a 28-year-old female who presented with prolonged vaginal bleeding following unsupervised intake of MTP pills at approximately six weeks of gestation. Despite undergoing two attempts of dilatation and evacuation (D&E) at a tertiary care center, retained products of conception persisted. On evaluation, transvaginal ultrasonography revealed a persistent intrauterine mass with calcification. A suspicion of false passage during the previous procedure was raised. Subsequent D&E under ultrasound guidance confirmed the presence of a false passage in the anterior uterine wall. The true uterine cavity was identified, and adherent calcified products were successfully removed using ovum forceps. The patient recovered well post-procedure. This case highlights the importance of ultrasound guidance during uterine evacuation especially in cases of suspected false passage and emphasizes the risks associated with unsupervised abortion practices.