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Uterine Inversion
Prof Khin Pyone Kyi Obstetric and Gynaecology Specialist Hospital, Nay Pyi Taw
Acute inversion of the uterus Definition
_Turning inside out of the fundus into the uterine cavity _Rare and serious obestetric emergency _Immediate management of shock and mannual repositioning of the uterus both reduce the morbidity and mortality Incidence _depends on geographic locationeg. 3 times higher in india than USA _decrease with active management of third stage
Causes mismanagement of third stage (premature traction on umbilical cord and fundal pressure before separation of placenta) Uterine atony Fundal insertion of the morbidily adherent placenta
syndrome 50%-no risk factor, no mismanagement of third stage
Classification First (Incomplete)-fundus extend to but not beyond the
cervical ring Second (Incomplete)-extend beyond the cervical ring but remain within the vagina Third (complete)- extend down to the introitus Fourth Degree(Total)-vagina also inverted
Symptoms Sudden cardiovascular collapse PPH and Hypovolaemic shock Severe abdominal pain
Clinical presentation Signs shock is out of proportionate to Bleeding Lump in the vagina Abdominal tenderness Absence of uterine fundus per abdomen Polypoidal red mass in vagina with placenta attached
Differential Diagnosis UVP
Fibroid polyp Postpartum collapse Severe uterine atony Neurogenic collapse Coagulopathy Retained placenta without inversion
Management
Resuscitation and repositioning simultaneously
Nonsurgical methods Manual replacement(Johnson method)-43-88% immediate reduction Hydrostatic method at OT( O’Sullivan method) Uterine rupture must be excluded first Placenta should be delivered only after repositioning and complete correction Uterotonic drugs Antibiotics cover
Role of tocolysis
In presence of cervical constriction ring Magnesium sulphate,nitroglycerine,
terbutaline Adverse effect of tocolytic mediated reduction in uterine tone----- PPH
Surgical methods Abdominal procedure
Huntingdon’s method Haultains’ method Cervical ring is incised posteriorly with
longitudinal incision
Recent techniques Under laparoscopic guidance Laparotomy and silastic cup used from above
