Uterine Inversion; A Case Report

Abstract

The puerperal uterine inversion is a rare and severe complication occurring in the third stage of labour. The mechanisms are not completely known. However, extrinsic factors such as oxytocic arrests after a prolonged labour, umbilical cord traction or abdominal expression are pointed. Other intrinsic factors such as primiparity, uterine hypotonia, various placental localizations, fundic myoma or short umbilical cord were also reported. The diagnosis of the uterine inversion is mainly supported by clinical symptoms. It is based on three elements: haemorrhage, shock and a strong pelvic pain. The immediate treatment of the uterine inversion is required. It is based on a medical reanimation associated with firstly a manual reduction then surgical treatment using various techniques. We report an observation of a 25 years old grand multiparous patient with a subacute uterine inversion after delivery at home.

Acute Uterine Inversion: Case Series from Paropakar Maternity and Women’s Hospital

“…10 The sudden severe pain is less frequent and is present in 7 to 10 % of cases. 7 In current study three out of four cases had blood transfusion upto seven units due to PPH. In a study of eleven inversions, six patients had blood loss greater than 1000 ml and three patients required blood transfusion.…”

“…Literature recommends using the neuromuscular relaxant molecules such as the magnesium sulphate, betamimetic, nitrate based products etcx. 7 In our study, in all four cases uterine reinversion was done at operation theatre under anesthesia, manually after correction of shock. Failing manual reduction, the hydrostatic method described by O'Sullivan should be attempted.…”

“…Its incidence is 1:27802 in a British hospital. 7 A retrospective study of acute puerperal inversion of the uterus undertaken at Women and Infants Hospital of Rhode Island revealed eleven inversions in 70,481 deliveries for an incidence of 1:6407. All were managed immediately which proves immediate correction of the inversion has high success rate, and loss of time may lead to surgical intervention.…”

Uterine inversion after an unskilled delivery – still a concern for maternal mortality: A case report and discussion of the related medico-legal issues

“…acute, subacute and chronic) is 83.4%, 2.62% and 13.9%, respectively. 5,9,10 It is classified into four stages where, in the first stage, the uterine base is in the uterine cavity and does not cross the cervix of the uterus. In the second stage, the uterine base crosses the cervix and is passed into the vagina.…”

Manual Reposition of Uterine Inversion with Hemorrhagic Shock in Minimal Facilities Situation

“…1 The presence of shock and hemorrhage, severe pain if the patient is awake, the absence of the uterus on abdominal palpation and the presence of a large round mass in the vagina must suggest the diagnosis immediately. 8,14 At the completion of the third stage of labor, we have to be cautious if the position of the uterus cannot be ascertained by abdominal examination. The initial shock associated with an inverted uterus is due to the stretching of the peritoneum and the nerves of the broad ligaments and may disappear almost immediately following reposition.…”