Life-threatening Haemorrhage following Over-the-Counter Use of MTP Pills in a Patient with Uterine Fibroid: A Case Report

Cervical and lower uterine segment leiomyomas can closely mimic Retained Products of Conception on grey-scale and Doppler ultrasonography, particularly when encountered in the setting of acute post-abortion haemorrhage. Hereby, the authors present a case of a 28-year-old Gravida 3 Para 2 Living 2 (G3P2L2) female with two previous caesarean deliveries who presented with heavy vaginal bleeding after intake of Medical Termination of Pregnancy (MTP) pills at 12 weeks of gestation. Transabdominal ultrasound revealed a heteroechoic lesion with internal vascularity in the lower uterine segment, initially interpreted as Retained Products of Conception (RPOC) or subchorionic haematoma. Emergency suction and evacuation were performed, with persistent bleeding necessitating uterotonics, intrauterine balloon tamponade, and blood transfusion; a subsequent postoperative fall in haemoglobin to 7 g/dL necessitated a second transfusion. Repeat post-procedure ultrasound demonstrated a homogeneously hypoechoic mass with persistent peripheral vascularity, raising suspicion of a leiomyoma; Magnetic Resonance Imaging (MRI) subsequently confirmed an intramural lower uterine segment fibroid. The present report focuses on the diagnostic dilemma between RPOC and a co-existing lower uterine segment leiomyoma. Unsupervised MTP pill use was the precipitating event, but the principal clinical learning point is the recognition of fibroid-mimicking sonographic patterns in post-abortion bleeding.