The authors present the case of a perforation of uterus at manual removal of placenta (MROP) treated conservatively. This patient was a low risk gravida 2, who had a retained placenta after a normal vaginal delivery. An uncomplicated MROP was performed and the patient was discharged home the next day. 5 weeks later she was readmitted with a large vaginal bleed and passed a small amount of retained products of conception. On ultrasound there was an adnexal mass which looked to be continuous with blood clot seen in the uterus. An MRI confirmed a defect in the myometrium of the lower uterus linking the adnexal mass with the endometrial cavity. As this patient's symptoms had settled, and she wished to consider further fertility, she was treated conservatively with regular MRI and US follow – up showing the defect gradually resolving. There is only one other case in the literature which shows a perforation at an otherwise uncomplicated MROP and this was associated with placenta accreta and managed surgically with a hysterectomy. This is the only case to detail conservative fertility preserving management.
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