CHAPTER 13 - RETAINED
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
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
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
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.
last review spring 2010