Uterine inversion

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Uterine inversion is a potentially fatal childbirth complication with a maternal survival rate of about 85%. It occurs when the placenta fails to detach from the uterus as it exits, pulls on the inside surface, and turns the organ inside out. It is very rare.

Causes[edit]

  • Mismanaged 3rd stage
  • Fundal pressure
  • Congenital weakness
  • Overzealous cord traction
  • Precipitate delivery
  • Uterine weakness

It is more common in multiple gestation than in singleton pregnancies.

Types[edit]

  • ONE: Complete. Visible outside the cervix.
  • TWO: Incomplete. Visible only at the cervix.[1]

Associations[edit]

Presentation[edit]

Uterine inversion is often associated with significant Post-partum Haemorrhage. Traditionally it was thought that it presented with haemodynamic shock "out of proportion" with blood loss, however blood loss has often been underestimated. The parasympathetic effect of traction on the uterine ligaments may cause bradycardia.

Management[edit]

Principles of management are to treat the shock and replace the uterus. Immediate manual replacement of the uterus has about a 20 - 40% chance of success. Removing the placenta increases blood loss. The cervix may need to be relaxed using tocolysis or general anaesthesia. Tocolytics include terbutaline, MgSO4, and Nitroglycerine (100mcg intravenously). If external replacement fails, a laparotomy may be required, in which the uterus is gently pulled the right way round using forceps.

References[edit]

  1. ^ Uterine inversion - Better Health Channel; State of Victoria, Australia; accessed 2009-04-03