A Case Report of Hysterotomy Performed to Remove Decapitated Head

Hysterotomy is a surgical procedure that entails making a deliberate incision in the uterus. While it is not frequently employed for abortions, its occurrence has risen due to the growing number of cesarean sections and cases of placenta accreta spectrum.

The present case report described a third gravida woman at 20 weeks of gestation who presented to the labor room with a decapitated fetus, where the body had been delivered but the head remained retained in the uterine cavity. 

She had a history of two live births and one prior cesarean section. After experiencing abdominal cramps, she sought assistance from an unskilled birth attendant, who attempted delivery, resulting in the decapitation of the fetus. 

Her general examination revealed that she was stable, but the internal cervical os was closed and fundal height was 14-16 weeks. All attempts to induce labor with Syntocinon were unsuccessful. Ultrasound showed the fetal head positioned near the uterine fundus and thinning of the prior surgical scar. 

In order to prevent potential injury to the uterus from the bony fragments of the decapitated head, a decision was made to perform a hysterotomy. The procedure was successfully carried out, and the fetal head was removed. The patient remained stable during the postoperative period and was discharged after four days.

Hysterotomy for abortion is a surgical method employed to end a pregnancy by removing the fetus and placenta through an abdominal incision. Among all abortion procedures, it involves the greatest risk of complications. Although this procedure is infrequently used, it may be necessary to ensure the complete termination of pregnancy, even in the second trimester and occasionally in the first trimester.

Source: Madan S, et al. Facing the unimaginable: Case series of hysterotomy at a tertiary care centre. Indian Journal of Obstetrics and Gynecology Research. 2024;11(3):504–506. https://doi.org/10.18231/j.ijogr.