Puerperal uterine inversion in the Netherlands: a nationwide cohort study

Abstract

Puerperal uterine inversion is a severe but rare obstetric complication of yet unknown origin. In this two-year study we determine the incidence of this complication and we describe associated risk factors to expose its etiology. All cases of uterine inversion were included from a nationwide cohort study which contained all 98 hospitals with a maternity unit in the Netherlands. We reviewed the medical records of 15 patients, resulting an incidence of approximately 1 in 20 000 vaginal births. Fourteen cases (93.3%) were classified as low-risk pregnancies at booking. Nulliparous women were not overrepresented and the main associated factors were signs of prolonged labor followed by third stage manipulation. This study is the first population-based study for uterine inversion. With the reported associated factors and occurrence in women with a low-risk profile, we show that every birth attendant should be able to detect this rare but severe complication.

Successful management of recurrent puerperal uterine inversion

“…Rarely, in the uncommon event of a placenta accreta/increta/percreta, removal proves difficult or impossible and the attempt markedly increases blood loss. 8 Because the diagnosis of abnormal placental adherence cannot be established until removal is attempted, the best plan is to wait till the patient is shifted to operating theatre room rather than to attempt immediate and perhaps incomplete removal. Failure of non-surgical techniques necessitates surgical techniques and the abdominal approach is favoured.…”

Akute Inversio uteri puerperalis: Eine Falldarstellung

“…Viele Studien haben Primiparität als Risikofaktor für die Uterusinversion beschrieben [8,9]. Auf der anderen Seite entspricht selbst in den Studien, in denen Erstgebärende einen großen Anteil an Uterusinversionen aufweisen, der Prozentsatz der Erstgebärenden in der untersuchten Population etwa dem Prozentsatz der Mehrgebärenden [1,2]. Die wichtigsten Risikofaktoren sind eine verlängerte Austreibungs-und Nachgeburtsphase, Makrosomie, Vakuumextraktion, Plazentaretention und Manipulationen in der Nachgeburtsphase [2,10,11].…”

Tranexamic acid as adjuvant treatment for postpartum hemorrhage: a systematic review protocol

“…assive transfusion usually is defined as a transfusion of 10 or more units of packed red blood cells within at cesarean delivery (74,75). Uterine inversion in a prior pregnancy leads to an increased risk in a subsequent pregnancy (1 per 26 subsequent deliveries) although it is still relatively uncommon (74).…”