Sonographic and MR features of puerperal uterine inversion

Abstract

Puerperal uterine inversion is a rare and potentially life-threatening complication of a mismanaged third stage of labour. Early diagnosis is mandatory for proper management of the patient. Complete uterine inversion is a clinical diagnosis. However, incomplete uterine inversion is difficult to identify and warrants further workup. Sonographic evaluation, although a bedside procedure, may be confusing. The conspicuity of findings is much greater on MR examination than on ultrasound. Only a few diagnostic imaging findings in uterine inversion have been described in previous reports. We present the case of a 26-year-old woman who had a full-term vaginal delivery and presented after 20 days with acute urinary retention and mild vaginal bleeding. She was diagnosed as a case of neglected subacute incomplete uterine inversion. Both greyscale and Doppler sonographic and MR features of the case are described with an emphasis on better delineation of uterine and adnexal anatomy on MR imaging.

Acute puerperal uterine inversion with successful manual transvaginal repositioning: A case report

“…[5,17] T1-weighted imaging is not useful, T2-weighted imaging shows clear anatomy, and it is important to identify the round ligaments and fallopian tubes, which are pulled medially, along with the uterine fundus, into the U-shaped uterine cavity. [18] About 83.4% of cases of postpartum uterine inversion are acute uterine inversion, [19] which is one of the most important causes of postpartum traumatic shock, hemorrhagic shock and puerperal infections. Due to the urgency of the situation, early recognition, aggressive antishock therapy, relief of uterine cramps, and prompt repositioning were the keys to treatment.…”

“…[5,17] T1-weighted imaging is not useful, T2-weighted imaging shows clear anatomy, and it is important to identify the round ligaments and fallopian tubes, which are pulled medially, along with the uterine fundus, into the U-shaped uterine cavity. [18]…”

Uterine inversion in retained placenta, that’s why a good management of third stage of labor matters: A case report

“…Controlled cord traction, a critical element of active management of the third stage of labor, along with early cord clamping and prompt administration of prophylactic uterotonics, plays a significant role in averting such events. 11 , 12 By implementing this measure, it is anticipated that the morbidity resulting from excessive bleeding such as hypovolemic shock after delivery would be significantly reduced.…”

“…If such emergency occurred in any healthcare facility, this sequence of care must be implemented urgently and simultaneously ( Figure 5 ). 12 …”

Laparoscopic Management of Didelphys Uterus with a Chronically Inversed Right Uteri

“…1, A and B). The possibility of uterus inversion was considered, and the patient was scheduled to undergo surgery after another menstruation cycle [1]. However, vaginal bleeding occurred, the bleeding increased gradually, and she was admitted after a visit to the emergency room.…”