Acute Uterine Inversion: A Report of Two Cases

Abstract

Acute inversion of the uterus is a serious but rare complication of the third stage of labor. The exact frequency of the complication is not known. Two cases seen and managed in the Obstetric Department of a district hospital are reported. The literature on this subject is reviewed; the possible causative factors and management techniques are discussed.

Inversion of the uterus: a serious complication at childbirth

“…The following factors can provoke an inversion: high intraabdominal pressure, traction of the umbilical cord, external forces and acting directly on the uterus (1). While mismanagement of the third stage of labor has been stressed as a causative factor, it should be remembered that cases of uterine inversion are few in relation to the total number of patients who receive active management in all stages of labor (5). In our two cases the placenta was delivered spontaneously.…”

“…During manual replacement tocolysis is recommended to relax the cervical ring and aid repositioning and general anesthesia. In the Huntington surgical procedure the cup of the uterine inversion is identified at laparotomy; Allis forceps are placed within the dimple of the inverted fundus and gentle upward traction is exerted on the clamps, with a further placement of forceps on the advancing fundus (1,2,5). Haultain's technique involves incising the cervical ring posteriorly with a longitudinal incision and facilitates uterine replacement by the Huntington method.…”

“…Some authors recommend removal of the placenta before repositioning the uterus. However, removal of the placenta prior to replacement causes some risk as the myometrium is easily torn, bleeding may be increased and shock aggravated while the maternal sinuses are exposed to sepsis (5). The incidence of uterine inversion during cesarean section is not known, but is reported to be extremely rare (6,7).…”

“…Haultain's technique involves incising the cervical ring posteriorly with a longitudinal incision and facilitates uterine replacement by the Huntington method. After replacement is complete, the uterus is repaired in two or three layers (1,2,5). By using vaginal Spinelli surgical repositioning, an incision is made median in the inverted part and lengthened until the inversion ring is cleaved.…”