Z Studziński1, D Branicka. 1. Oddział Połozniczo-Ginekologicznego Samodzielnego Publicznego Wojewódzkiego Szpitala Zespolonego w Słupsku.
Abstract
OBJECTIVES: Acute puerperal uterine inversion is a rare but very feared obstetrical complication. It determines an almost immediate shock and serious metrorrhagia. It is a introflexion of parietes uteri which takes place during the third stage of labor or during the first hours of puerperium. It can be distinguished in inversion of I, II or III degree according to the zone concerned by the introflexion: only the fundus of the uterus, all the corpus emerging in the vagina or the entirety of the uterus coming out from the vulvar orifice. RESULTS: This is report a case of inversion of the uterus during third stage of labor in multiparous aged 24 years admitted to Department of Gynecology & Obstetric in Hospital of Słupsk. The uterine III degree inversion was spontaneous during third stage of labor and was immediately diagnosed. Manual manipulation was attempted immediately to reverse the inversion but it was not successful. Because patient fell in cardiovascular shock she was resusciated and the inverted uterus repositioned using Huntington's method under general anaesthesia. After intra-abdominal repositioning of the uterus the placenta was removed manually and intramural injection of oxitocine was done to avoid immediate relapse. Whole obstetrical procedure was carried out within one-half hour after inversion. CONCLUSIONS: Although uncommon, in left unrecognized, uterine inversion will result in severe hemorrhage and shock, leading to maternal death. Manual manipulation should be attempted immediately to reverse the inversion. In the most resistant of inversions, surgical correction might be required. Following inversion of the uterus, further normal pregnancies can be expected.
OBJECTIVES: Acute puerperal uterine inversion is a rare but very feared obstetrical complication. It determines an almost immediate shock and serious metrorrhagia. It is a introflexion of parietes uteri which takes place during the third stage of labor or during the first hours of puerperium. It can be distinguished in inversion of I, II or III degree according to the zone concerned by the introflexion: only the fundus of the uterus, all the corpus emerging in the vagina or the entirety of the uterus coming out from the vulvar orifice. RESULTS: This is report a case of inversion of the uterus during third stage of labor in multiparous aged 24 years admitted to Department of Gynecology & Obstetric in Hospital of Słupsk. The uterine III degree inversion was spontaneous during third stage of labor and was immediately diagnosed. Manual manipulation was attempted immediately to reverse the inversion but it was not successful. Because patient fell in cardiovascular shock she was resusciated and the inverted uterus repositioned using Huntington's method under general anaesthesia. After intra-abdominal repositioning of the uterus the placenta was removed manually and intramural injection of oxitocine was done to avoid immediate relapse. Whole obstetrical procedure was carried out within one-half hour after inversion. CONCLUSIONS: Although uncommon, in left unrecognized, uterine inversion will result in severe hemorrhage and shock, leading to maternal death. Manual manipulation should be attempted immediately to reverse the inversion. In the most resistant of inversions, surgical correction might be required. Following inversion of the uterus, further normal pregnancies can be expected.