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 theuterus theuterus as it exits, pulls on the inside surface, and turns the organ inside out. It is very rare.
Ca u s e s [ e d i t ] The most common cause is the mismanagement of 3rd stage of labor, such as !undal pressure
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"xcess cord traction during the 3rd stage of labor
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#ther natural causes can be $terine weaness, congenital or not
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&recipitate delivery
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'hort umbilical cord
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It is more common in multiple gestation than in singleton pregnancies. The incidence is of ()*+++ pregnancies.
T y p e s [ e d i t ] #" -omplete. isible outside the cervix cervix.. T/# Incomplete. isible only at the cervix. cervix. 0(1
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As s o c i a t i o ns [ e d i t ] •
&lacenta praevia
!undal &lacental Implantation
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$se of 2agnesium 'ulfate
igorous fundal pressure
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epeated cord traction
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short umbilical cord
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Pr e s e nt a t i o n[ e d i t ] $terine inversion is often associated with signi4cant &ostpartum hemorrhage. hemorrhage. Traditionally Traditionally it was thought that it presented with haemodynamic shoc 6out of proportion6 with blood loss, however blood loss has often been underestimated. The parasympathetic parasympathetic e7ect e7ect of traction on the uterine ligaments may cause bradycardia bradycardia..
Ma na g e me nt [ e d i t ] &rinciples of management are to treat the shoc and replace the uterus. The patient should
be moved rapidly to the # to facilitate anesthesia monitoring during this procedure. $sually this complication is only recognied after delivery of the placenta, wherein pitocin has already been started, which 9ust exacerbates the problem. The uterus clamps down around the inversion maing it very di:cult to perform a replacement. This is a true obstetrical emergency, so extra doctors, nurses, anesthesiologists should be summoned to the room to assist. The pitocin should be turned o7 immediately. ;iving tocolytics such as terbutaline or magnesium sulfate have a lower success rate.
have a higher success rate. #nce you have achieved uterine relaxation, place your 4st into the vagina. !ind the biggest part of the inversion and push with your 4st cephalward to replace the uterus. This taes 4rm steady force, so eep your 4st in the vagina if you need to rest your hand. Then continue more force toward the fundus to replace the uterus. ?ou can use your left hand on the outside of the abdomen to help you feel where the fundus should be replaced. This helps guide the angle of your 4st in replacing the uterus. #nce it is replaced, give the patient 2isoprostol (+++ mcgs rectally to help with increasing uterine tone. #ther medications such as 2ethergine and
