The treatment for chronic uterine inversion is surgical that includes both abdominal and vaginal approaches. Inversion varies in degree from a mere dimpling of the fundus to involvement of the whole uterus. Treatment options depend on the severity, but could include reinserting the uterus by hand, abdominal surgery or emergency hysterectomy. A high index of suspicion is required to make a prompt diagnosis. The full range of problems that can cause uterine inversion is not fully understood, but in many cases it includes the incomplete separation of the. Sonographic evaluation, although a bedside procedure, may be. Nonpuerperal uterine inversion in association with.
It occurs chiefly when the uterus acts to expel a submucous leiomyoma with fundal attachment. Profuse vaginal bleeding, the absence of uterine fundus on abdominal examination, and hypovolemic shock with severe hypotension are clues to the diagnosis 4 12. Management of uterine inversion free download as powerpoint presentation. Request pdf on researchgate inversion uterina puerperal. It is classically described in serious obstetric complications. If unable to reposition then wrap in sterile gauze swabs soaked in warm water, wrap in plastic bag and then towel to attempt to retain warmth and moisture or placed inside of the vagina. Mismanagement of 3rd stage caused by pressure on the fundus or traction on the cord when the uterus is relaxed or. Uterus was pale and flabby and bleeding was present from the rupture site. Attempt to reposition the uterus do not try to deliver the placenta if still in situ 3.
You are free to copy and communicate the work in its current form for noncommercial purposes, as long as you attribute the state of. Extrusion of the inner uterine lining into the vagina or extending past the vaginal introitus. The authors describe a case of complete uterine inversion. Puerperal uterine inversion may be classified as four degrees according to the stage of uterine exteriorization. If not promptly recognized and treated, uterine inversion can lead to severe hemorrhage and shock, resulting in. Uterine inversion is an introflexion of parietes uteri, which takes place during the third stage of labor, or during the 1st h of puerperium. Chronic nonpuerperal uterine inversion and necrosis.
It usually occurs in the second stage of labour and is a lifethreatening complication requiring prompt diagnosis and definitive management. Prompt diagnosis and the proper choice of treatment will decrease the morbidity and mortality associated with this complica tion. In a non puerperal situation, it is most often due to the development of a process that is. Case report nonpuerperal uterine inversion following a. A 56yearold postmenopausal woman presented with increased, painless bleeding for 10 days. When managed promptly and aggressively, uterine inversion can result in minimal maternal morbidity and mortality. Uterine inversionclassificationcauses and management of. Acute uterine inversion is an emergent obstetric situation 5. A condition that may occur during the third stage of labor in which a relaxed uterus is turned inside out, causing the internal surface to protrude into the vagina. Non puerperal uterine inversion pubmed central pmc. Treato found 6 discussions about uterine inversion and uterine atony on the web. Uterine inversion occurs when the uterine fundus collapses in the endometrial cavity turning the uterus partially or completely turned inside out and may protrude.
Uterine inversion refers to a descent of the uterine fundus to or through the cervix, so that the uterus is turned inside out. Dr swati agrawal 1, 2, dr kumar jayant 3, dr susheela khoiwal 4, dr rajendra agrawal 2. The full range of problems that can cause uterine inversion is not fully understood, but in many cases it includes the incomplete separation of the placenta from the uterine wall. Department of gynaecology and obstetrics, canisius. Scribd is the worlds largest social reading and publishing site. Uterine inversion is considered a rare obstetrical problem associated with pregnant women and mostly noted during labor and delivery particularly in the second stage, where members of the health team has to be vigilant with its assessment findings, have a timely diagnosis of the problem and implement standard measures to prevent the risk of postpartum bleeding as a consequence. In one institution there were nine cases during an 11year period, a rate of one for every 2176 vaginal deliveries. Introduction uterine inversion occurs when the uterine fundus collapses into the endometrial cavity, turning the uterus partially or completely inside out. Early diagnosis is mandatory for proper management of the patient. The presentation of puerperal uterine inversion can be acute within 24 h of delivery, subacute over 24 h and up to the 30th postpartum day, or chronic 30 days after delivery. Non puerperal inversion is extremely rare, representing about one sixth of all inversions 8.
Rarely inversion may occur not in association with pregnancy risk factors include pulling on the umbilical cord or pushing on the top of the uterus before the placenta has detached. Acute puerperal inversion of the uterus is considered to be rare. Herein a case of uterine inversion caused by myoma protruding through vagina is presented. However, incomplete uterine inversion is difficult to identify and warrants further workup. Complete uterine inversion is a clinical diagnosis. Acute uterine inversion is a life threatening and unpredictable obstetric emergency which if ignored can lead to severe haemorrhage and shock which may be out of proportion to haemorrhage. Placenta accreta denotes an abnormal placental adherence onto, into, or through the uterine wall, either partial or total, which leads to difficulty in delivery of the placenta. The condition should be recognized quickly and managed appropriately by a multidisciplinary team, in order to minimize maternal morbidity and mortality. Definition when uterus turns inside out, it is called uterine inversion. Incidence of puerperal uterine inversion greatly varies in literature ranging from 1. Oct 26, 2018 uterine inversion is a rare complication of childbirth that occurs when part of the uterine wall collapses and turns inside out, sometimes even protruding through the cervix and into the vagina. Obstetrics uterine inversion this work is licensed under the creative commons attributionnoncommercialnoderivatives v4.
Predisposing factors include multiparity, a broad uterine shape including. Care for acute uterine inversion involves pain management, resuscitation and replacement of the inverted uterus before oedema sets in. Nonpuerperal inversion of the uterus is a much less frequent occurrence, and uterine inversion due to uterine sarcoma is extremely rare with 17 cases reported in the medical literature since 1887. Uterine inversion has a good prognosis when managed in timely correct manner. Oct 17, 2014 uterine inversion is a rare obstetric emergency that can lead to hypovolemic shock or even maternal death. Summary uterine inversion is a rare but serious complication. Modules vaginal delivery by vacuum communication skills cord prolapse uterine inversion management of retained placenta antenatal risk assessment. Obstetric haemorrhage includes antepartum haemorrhage, uterine inversion and anaesthetic problems in pregnancy updated modules. Symptoms and conditions also mentioned with uterine atony in patients discussions. Puerperal uterine inversion and shock british journal of anaesthesia.
Inversion varies in degree from a mere dimpling of the fundus to involvement of the whole uterus and cervix. Uterine inversion and postpartum hemorrhage em cases. The uterine inversion happened when the uterus retracted to expel the submucous myoma with fundal attachment. Treatment options depend on the severity, but could include reinserting the uterus. He joined us december 11th via csection and is perfect all 9 lbs 2 oz of him big baby. The eighteenth case reported here occurred in a premenopausal nulliparous 26yearold female. Chronic total uterine inversion in a young adult patient ncbi. When this happens, the top of the uterus the fundus comes through the cervix or even completely outside the vagina. Uterine inversion is a potentially fatal complication of childbirth.
Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Symptoms include postpartum bleeding, abdominal pain, a mass in the vagina. Uterine inversion is an emergency requiring rapid diagnosis and prompt treatment to prevent maternal mortality. Symptoms include postpartum bleeding, abdominal pain, a mass in the vagina, and low blood pressure. It can lead to massive bleeding, shock, and can even be fatal. It is a rare complication of vaginal or cesarean delivery, but when it occurs, it is a lifethreatening obstetric emergency. Although the complication is very rare, every obstetrician should be familiar with the techniques of uterine repositioning.
There are many management strategies, but they are poorly described and dispersed in the medical literature. Mar 12, 2014 puerperal uterine inversion is a rare and potentially lifethreatening complication of a mismanaged third stage of labour. Uterine inversion is a rare complication of childbirth thats very serious and can be life threatening. Risk factors include pulling on the umbilical cord or pushing on the top of the uterus before the. A uterine inversion is a rare and serious condition. Inversion of uterus means uterus is turned inside out partially or completely. Prompt 2 train the trainers prompt 2 train the trainers 53bae198b3554aee81b90785aeda520d 2 overview 2 overview the royal college of obstetricians. Although it is a rare postpartum complication with a reported incidence varying between 1 in 2000 to 1 in 50,000 live births 1, it can also occur spontaneously in patients with uterine cavity tumors like leiomyoma, teratoma, and sarcoma 2 3 4. Set up four drip sets with warm saline, place the open ends of the tubing into the vagina in the palm of an examining hand, and pack a towels around the examining wrist to seal the vaginal introitus.
This article reports a case of non puerperal uterine inversion, illustrating the correlation between mri and intraoperative images. Uterine inversion is a very rare gynecological complication that represents a real emergency. Mar 10, 2016 non puerperal uterine inversion is a rare condition that can be easily diagnosed with mri. Uterine inversion is the folding of the fundus into the uterine cavity in varying degrees.
The diagnosis is based on the clinical presentation and findings on pelvic examination. Chronic uterine inversion secondary to submucous fibroid. Classification inversion of uterus is classified in mainly 3 types. Promptly identify and assist with the resolution of uterine inversion. Uterine inversion is a condition in which the uterus turns inside out with prolapse of the fundus through the cervix. A clinical diagnosis of nonpuerperal uterine inversion was made and she successfully underwent vaginal hysterectomy. Dec 10, 2015 uterine inversion, either partial or complete, is a rare but serious obstetric complication. Placenta accreta and uterine inversion are unusual but serious problems. Puerperal inversion of the uterus is a dramatic and dangerous complication. Uterine inversion most commonly is caused by traction on an umbilical cord attached to a yetadherent placenta or to application of forceful fundal pressure to. This work is licensed under the creative commons attributionnoncommercialnoderivatives v4. Nonpuerperal uterine inversion is a rare condition that can be easily diagnosed with mri. By extirpating the stalk the fundus was also resected, causing a uterine rupture.
Before i get rolling into whats going on at 30 weeks, i want to hit on a few milestones that ive missed updating on. This can be dangerous because the mother can hemorrhage and experience quite a bit of bleeding. There are factors that put some women at a higher risk, but the condition can. Uterine inversion either partial or complete is a serious but rare obstetric complication. By definition, uterine inversion is the collapse of the uterine fundus through the endometrial cavity and the cervix. Uterine inversion gynecologic and obstetric surgery wiley online. Dec 29, 20 posted by katielynn221 in pregnancy after inversion on december 29, 20 baby rt is here. Subacute puerperal third degree uterine inversion a rare case. Time between delivery of baby and delivery of placenta. Posted by katielynn221 in pregnancy after inversion on october 7, 20 wow, i managed to get a little sidelined with posting pregnancy updates. In this condition the fundus of the uterus extend to, or through the cervix and it may come out of the vagina. An alternative method of dealing with uterine inversion is hydrostatic replacement. Complete inversion describes an inverted fundus that extends beyond the external os a prolapsed inversion is one in which the inverted uterine fundus extends beyond the vaginal introitus a total inversion, usually nonpuerperal and tumor related. Uterine inversion is when the uterus turns inside out, usually following childbirth.
Hydrostatic method, transurethral resection of prostate set, uterine inversion. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Uterine inversion is a serious but rare complication of childbirth in which the uterus literally turns inside out after the baby is delivered. Uterine inversion means the placenta fails to detach from the uterine wall, and pulls the uterus insideout as it exits. Rarely inversion may occur not in association with pregnancy. Non puerperal uterine inversion is a rare condition that can be easily diagnosed with mri. A 56yearold african american woman presented to our emergency center with complaints of a mass protruding from her vagina.
Uterine inversion definition of uterine inversion by. Acute uterine inversion has a rare occurrence and is a catastrophic obstetric emergency. In the present case, a 37yearold woman without any remarkable history developed acute puerperal uterine inversion after the successful induction of labor. Pregnancy after inversion life after uterine inversion.
This article reports a case of nonpuerperal uterine inversion, illustrating the correlation between mri and intraoperative images. As uterine inversion is a rare event, it makes sense and seems to be necessary that new data are presented and. Goals of care include management of hemodynamic instability, reduction of the inversion and prevention of recurrence using uterotonic medications. Pdf nonpuerperal acute uterine inversion in a nullipara.1243 1328 918 391 127 81 61 1488 725 235 1093 597 318 662 1530 957 1191 828 1011 1551 1321 3 237 459 1001 1086 1116 521 485 1274 732 1258