It happens that a termination of pregnancy does not succeed and that the pregnancy continues undisturbed. This is mostly due to negligence during the procedure or inexperience of the doctor. But occasionally it happens to the most experienced and after following the most exact routine.

A patient was treated who was about 8 weeks pregnant. Apparently the procedure was uneventful. As a routine I checked the removed tissues and I found it adequate for the pregnancy duration. About three months later the patient informed me that she was still pregnant. A scan showed a normal pregnancy of the right gestational age. In this case the woman and her husband decided to accept the pregnancy and they only wanted repayment of the fee. Later they sent me a birth card. The child was in all aspects normal.

Retention of pregnancy occurs in the following situations:

1. Treating a very young pregnancy. It is possible that the nidation site is missed, or the termination is attempted with a narrow canula which does not succeed in removing the tissues. This happens particularly in so-called overtime treatment, see Chapter 6.

2. Failing to enter the uterus. It may happen that the cervix is curetted only. This may occur in cases of a marked Hegar's sign or a strong ante- or retroflexion .

3. If the uterus is very irregular, for instance in a fibromatous uterus, it is possible to fail to remove the tissues.

4. In case of duplication of the genital tract a non-pregnant hemiuterus may be emptied. This situation is described in Chapter 11.

5. If there is an ectopic pregnancy the uterus may be emptied but the preg nancy is not disturbed.

The following precautions should be taken:

1. Do not appoint patients before the eighth week of pregnancy. Eight weeks is the ideal moment where the procedure is easiest and the check of the tissues can almost certainly confirm the completion of the procedure.

2. Examine the uterus by means of ultrasound scan to find such conditions as extreme flexion or duplication or ectopic.

3. Always check the tissues as described in Chapter 9. Remember that aspiration in case of ectopic pregnancy or non-pregnant hemiuterus yields much tissue which however is different than in case of a normal preg nancy .

4. Repeat the ultrasound scan in case of any doubt, or even as a routine.

5. Always tell the patient that there is a remote chance of failure of the procedure and arrange a follow up examination after a month or so. At least the patient should report if she does not get her period after six weeks.Although very rare the situation may cause considerable trouble. It may be worthwhile to ask the patient to sign a disclaimer of responsibility. The exact form or wording hereof should be compiled by a lawyer.


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last review spring 2010