Uterine Inversion-Classification-Causes and Management Of Uterine Inversion

Uterine Inversion:

Uterine inversion either partial or complete is a serious but rare obstetric complication. In this condition the fundus of the uterus extend to, or through the cervix and it may come out of the vagina. It usually occurs in third stage of labour. This is a life-threatening condition and require prompt diagnosis and definitive treatment. Very rarely it may occur in non pregnant patients and in these patients it is usually associated with prolapsing uterine fibroids. Although it may occur in association with other tumors.

Classification Of Uterine Inversion:

First Degree Inversion:

The inverted fundus extend to, but not through the cervix.

 

Second Degree Inversion:

The inverted fundus extend through the cervix but remain inside the vagina

Third Degree Inversion:

The inverted Fundus extend outside the vagina.

Total Inversion

The vagina and uterus both are inverted.

Causes  and Risk Factors Of Uterine Inversion:

Uterine inversion is usually a complication of third stage of labour. It normally occurs when traction is applied to the umbilical cord while uterus is relaxed. Other causes include:
1. Short umbilical cord
2. Excessive traction to the cord
3. Applying excessive fundal pressure
4. Fundal implantation of the placenta
5. Retained placenta
6. Placenta Adherens ( Placenta Acreta, Increta and Percreta )
7. Chronic Endometritis
8. Vaginal birth after previous cesarean section.
9. Rapid or long labour
10. Previous uterine inversion
11. Certain drugs such as magnesium sulphate (drugs that promote tocolysis)

Symptoms and signs:

1. Acute lower abdominal pain
2. Profound shock of neurogenic or hemorrhagic origin
3. Visible inverted fundus.

Management Options:

Hypotension and hypovolemia require aggressive fluid and blood replacement.

1. Get help: Consult most experienced consultants and this should include most experienced anesthesiologist.
2. Make sure further intravenous access with large bore cannula and commence fluid with Ringers lactate.
3. Insert a urinary catheter.

Immediate uterine repositioning is essential for acute puerperal inversion. Measures may include;

1. Get help and prepare operation theater for emergency laparotomy.
2. Administer tocolytics for uterine relaxation, for example,
a) Nitroglycerine ( 0.25 – 0.5 mg ) intravenously in two minutes
b) Terbutaline ( 0.1 – 0.25 mg ) slow intravenously
c) or Magnesium sulphate ( 4 – 6 grams ) intravenously over 20 minutes

See also:

Complications Of Third Stage Of labour
Placenta Acreta – Increta – Percreta
Uterine Rupture