Treatment of puerperal uterine inversion by the hydrostatic method; reports of five cases

Subacute uterine inversion following an induced abortion in a teenage girl: a case report

Background

Subacute uterine inversion is a very rare complication of mid-trimester termination of pregnancy that should be considered in a situation where unsafe abortion occurs.

Case presentation

We present a case of subacute uterine inversion complicated by hypovolemic shock following an unsafe abortion in a 17-year-old nulliparous unmarried girl. She presented with a history of collapse, mass protruding per vagina that followed Valsalva, and persistent lower abdominal pain but not vaginal bleeding. This followed her second attempt to secretly induce an abortion at 18 weeks amenorrhea. On examination, she was agitated, severely pale, cold on palpation, with an axillary temperature of 35.8 °C, a tachycardia of 143 beats per minute and unrecordable low blood pressure. The abdomen was soft and non-tender with no palpable masses; the uterine fundus was absent at its expected periumbilical position and cupping was felt instead. A fleshy mass with gangrenous patches protruding in the introitus was palpated with no cervical lip felt around it. We made a clinical diagnosis of subacute uterine inversion complicated with hypovolemic shock and initiated urgent resuscitation with crystalloid and blood transfusion. Non-operative reversal of the inversion failed. Surgery was done to correct the inversion followed by total abdominal hysterectomy due to uterine gangrene.

Conclusion

Our case highlights an unusual presentation of subacute uterine inversion following unsafe abortion. This case was managed successfully but resulted in significant and permanent morbidity.

Cardiac arrest following acute puerperal uterine inversion

Although uterine inversion is a potentially life-threatening complication of childbirth, there are only six case reports of cardiac arrest due to acute inversion to date. We report a successful outcome in a patient with sickle cell disease who had a witnessed cardiac arrest due to acute puerperal uterine inversion. Revival from cardiac arrest and resuscitation was followed by manual repositioning of the uterus. She gradually recovered from the acute kidney injury that developed as sequelae of the cardiac arrest and subsequent circulatory shock. Awareness of this rare complication and timely intervention is the key to a successful outcome in these patients.

Total and acute uterine inversion after delivery: a case report

Introduction

Uterine inversion is a rare obstetric emergency that can lead to hypovolemic shock or even maternal death. There are many management strategies, but they are poorly described and dispersed in the medical literature. The purpose of this article is to describe a case of complete acute uterine inversion and a review of the literature.

Case presentation

The authors describe a case of complete uterine inversion after a normal delivery with fundal placenta and without cord traction, in a 33-year-old Caucasian woman. After the diagnosis was made and after several attempts of manual correction of the inversion, the patient was taken immediately to the operating room and a laparotomy was performed. With opposing pressures in the cervical ring through the abdominal cavity and on the uterus fundus through her vagina, the inversion was resolved. An incision on the cervical ring was unnecessary. Due to incomplete detachment of the placenta the bleeding was mild. She recovered without complications and the histological examination of placenta was unremarkable. In this case, the only risk factor for uterine inversion was the fundal implantation of the placenta.

Conclusions

The low incidence of uterine inversion leads to sparse experience in resolving this obstetrical emergency. The best prognosis occurs in situations where the diagnosis and maneuvers for uterine reversal are made at an early stage. The authors concluded that opposing pressures in the cervical ring through the abdominal cavity and on the uterus fundus through the vagina can resolve the inversion without the need of other surgical techniques. It is essential to keep in mind this diagnosis, and be updated about the strategies required to solve this complication.

Acute uterine inversion: a simple modification of hydrostatic method of treatment

BACKGROUND

Hydrostatic method for reducing acute uterine inversion is simple method, if advocated properly.

AIM

The aim of this study is to reduce the failures in technique in O'Sullivan's method in acute puerperal uterine inversion hence reducing maternal mortality and morbidity.

SUBJECTS AND METHODS

This study was conducted over a f 6 year period s from 2007 to 2013. Women with acute uterine inversion immediately after delivered were included in the study. Repositioning of acute uterine inversion in six patients in emergency was done using trans-urethral resection of prostate set (TURP set), used in endoscopic resection of prostate, and two 3 L saline bags.

RESULTS

The repositioning was successful in all requiring no anesthesia.

CONCLUSIONS

This technique modification is improvisation of hydrostatic pressure with a trans-urethral resection of prostate set (TURP set) and 3 L saline bags and it is simple and effective and will definitely save women's lives; thus, reducing maternal morbidity and mortality.