Acute Uterine Inversion

Lecturer; Dr. Inzama Wilfred

Dept; Obstetrics & Gynecology
30th/08/2019
 Introduction
• Life threatening complication in third of labour
• Incidence varies widely between 1in 2000 to 1
in 50000
• Largely deeps on standard of management of
third stage of labor
 Classification
 Acute uterine inversion; within 24 hrs of
delivery
 Sub-acute uterine inversion; between 24 hrs
to 4 weeks of delivery
 Chronic uterine inversion; after 4weeks after
delivery
 Types of uterine inversion
 Incomplete; fundus of the uterus has turned
inside out, but the inverted fundus has not
descended though the cervix, also know type I
 Complete; inverted fundus has passed
completely through the cervix to lie within the
vagina or, less often outside the introitus, also
known type I & II respectivefully
 Causes
 Mismanagement of third stage of labour
 Fundal pressure to aid delivery
 Abnormally short cord
 Sudden rise of intra abdominal pressure e.g. cough,
vomiting
 Morbid adherence of a fundally implanted placenta
 Mannual removal of the placenta
 Connective tissue disorders like Marfan’s syndrome.
 Clinical presentation
 Severe and sustained hypogastric pain in the third stage
of labor
 Shock that is out of proportion with apparent blood loss
 Associated haemorrhage and hypovolaemic shock
 With complete inversion the uterus is not palpable per
abdomen and the inverted is either obvious at the
introitus
 In case of incomplete inversion, fundus may feel normal
except in very thin women where you may feel a dimple
 Management
 Consent from the patient
 Preoperative antibiotics
 Try immediate manual replacement
 Call for help
 Intravenous crystalloids (large bore cannula 2)
 Blood for grouping and cross match
 Catheterize
 Analgesia
 Anesthesia (preferably general anesthesia)
 Tocolysis (terbutalene & salbutamol)
 Manual replacement of the uterus
 Surgical method after failed manual replacement
 Oxcytocic for 8-12 hours to keep the uterus contracted
Manual replacement of the uterus
• The uterine fundus is cupped in the palm of the hand.
• The fingers and thumb are extended to feel the utero-
cervical junction, to systematically & sequentially push
and squeeze the uterine wall back through the cervix
• This pressure is sustained for 3-5 minutes to achieve
complete replacement
• Keep the finger in the uterus and start oxytocin infusion
to keep the uterus contracted
• When the uterus is felt contracted, then remove the
hand slowly
 Other method
 O’sullivan’s hydrostatic replacement
technique
Surgical methods
 Huntington’s operation
 Haultain’s operation