Peterson, who is studying post-abortion women in Germany, believes that when deep feelings of guilt which have been suppressed for a long time are followed by “a breakthrough of destructive deep awareness, with chaos and panic, revulsion and hate” these feelings must be acknowledged and the woman helped to come to “acceptance of existing reality, responsibility and feeling of guilt toward the dead child.” (12) It is my experience that only when the therapist can endure the flood of primitive emotions which the patient needs to pour out over a number of sessions without rejecting her or asking her to diminish their intensity, can he or she begin to help the post-abortion woman in her work of mourning.
Patient was resuscitated with crystalloids. She had an emergency laparotomy. Perforation was noted at the fundus with loops of jejunum and ileum entering into the uterus. Mesentery was stripped off from the bowel loops at mesenteric border without serious vascular disruption. There was about 500 ml of blood in the pelvis. Large bowel was intact. Remnants of the small bowel loops were clamped and four meters of bowel was resected. End-to-end anastomosis was done with remaining three feet of jejunum and two feet of ileum. Uterine perforation was sutured. Mutilated fetus that migrated during curettage was found at right paracolic gutter. Tubectomy was not done as the patient refused to give consent pre-operatively for permanent sterilization. She recovered well following surgery. On follow-up ultrasonogram, uterus showed no product of conception. Patient was discharged after a week with advice on diet and family planning.