Please cite this paper as: Antonelli E, Irion O, Tolck P, Morales M. Subacute uterine inversion: description of a novel replacement technique using the obstetric ventouse. BJOG 2006; 113:846-847. Case reportA 27-year-old black African primigravida with an uneventful antenatal course was admitted in active labour at term. Six hours following admission, the cervix was fully dilated. The second stage of labour lasted 45 minutes and a 3200-g male infant was born without apparent complications. Five units of oxytocin were given intravenously with delivery of the anterior shoulder, and the complete placenta delivered spontaneously 15 minutes later without any need for cord traction. The postpartum period was uneventful until day 4 when the woman complained of acute pelvic pain associated with the desire to pass urine. Increased vaginal bleeding was noted at the same time. Vaginal examination revealed complete uterine inversion. The woman was taken immediately to the operating theatre, where an initial attempt at manual replacement under epidural analgesia was unsuccessful because of a constricted cervix. Terbutaline was administrated intravenously but a further effort at replacement failed and it was decided that a surgical reduction should be undertaken. Laparotomy revealed a complete uterine inversion, with bladder and ovaries pulled down through the inverted uterus. A Silastic Ò cup (Silc-cup; Menox AB, Gothenburg, Sweden) was easily inserted into the inverted uterus ( Figure 1A), a vacuum was created and a gentle traction achieved reduction of the inversion ( Figure 1B). Digital examination demonstrated an empty uterine cavity and an intact cervix. Twenty units of oxytocin were then administrated intravenously by slow infusion over 12 hours and broad-spectrum antibiotics were prescribed. The woman was discharged well 4 days later.
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