Treatment of complete subacute postpartum uterine inversion: the case report
DOI:
https://doi.org/10.15574/PP.2024.98.115Keywords:
subacute uterine inversion puerperal, treatment, hysterectomyAbstract
Acute postpartum uterine inversion is a rare and unpredictable complication, usually in the third stage of labor, with the development of massive hemorrhage and shock, which can lead to significant morbidity and mortality. An even more rare scenario faced by the gynecologist is subacute uterine inversion. Most often, postpartum uterine inversion is caused by early or excessive traction on the umbilical cord and/or pressure on the fundus of the uterus before separation of the placenta (Crede maneuver) during the third stage of labor. The diagnosis is based on clinical data - the presence of a smooth round mass protruding from the cervix or vagina. When examining the abdominal cavity, the key finding is the absence of the uterine fundus during palpation in the area of its normal location. Management of postpartum uterine inversion includes: return of the uterine fundus to the correct position, prevention and treatment of postpartum hemorrhage and shock, prevention of repeated inversion.
The aim is to describe the features of diagnosis and treatment of subacute postpartum uterine inversion of the IV degree.
Clinical case. A report of a clinical case of subacute postpartum uterine inversion of the IV degree in a 29-year-old woman in labor, who was successfully treated using the Huntington's procedure and subsequent total hysterectomy with fallopian tubes, is presented.
Conclusions. Given that acute postpartum uterine inversion is an extremely rare clinical phenomenon in obstetric practice, early recognition of this pathology is a difficult task, especially in cases of inversion of the I or II degree, when it can imitate a myomatous nodule. Although rare, uterine inversion should be carefully evaluated in any case of maternal collapse in the presence of signs and symptoms such as postpartum hemorrhage, lower abdominal pain, and/or the presence of a smooth, round mass protruding from the cervix or vagina. For the most favorable prognosis, not only early high-quality diagnosis is important, but also timely treatment in order to avoid the need for hysterectomy. In cases of subacute and chronic uterine inversion, surgical treatment should be considered, since the inverted walls of the uterus have reduced elasticity due to involution.
This study did not involve any experiments on animals or humans. Written informed consent for treatment and publication of this case was obtained from the patient.
No conflict of interests was declared by the authors.
References
Achanna S, Mohamed Z, Krishnan M. (2006). Puerperal uterine inversion: a report of four cases. J Obstet Gynaecol Res. 32 (3): 341-345. https://doi.org/10.1111/j.1447-0756.2006.00407.x; PMid:16764627
Baskett TF. (2002). Acute uterine inversion: a review of 40 cases. J Obstet Gynaecol Can. 24 (12): 953-956. https://doi.org/10.1016/S1701-2163(16)30594-1; PMid:12464994
Bhalla R, Wuntakal R, Odejinmi F, Khan RU. (2009). Review acute inversion of the uterus. Obstetrics and Gynecology. 11 (1): 13-18. https://doi.org/10.1576/toag.11.1.13.27463
Calder AA. (2000). Emergencies in operative obstetrics. Baillieres Best Pract Res Clin Obstet Gynaecol. 14 (1): 43-55. https://doi.org/10.1053/beog.1999.0062; PMid:10789259
Chambrier C, Zayneh E, Pouyau A, Pacome JP, Bouletreau P. (1991). Uterine inversion: an anesthetic emergency. Ann Fr Anesth Reanim. 10 (1): 81-83. https://doi.org/10.1016/S0750-7658(05)80275-8; PMid:2008975
Coad SL, Dahlgren LS, Hutcheon JA. (2017). Risks and consequences of puerperal uterine inversion in the United States, 2004 through 2013. Am J Obstet Gynecol. 217 (3): 377.e1-377.e6. https://doi.org/10.1016/j.ajog.2017.05.018; PMid:28522320
Dali SM, Rajbhandari S, Shrestha S. (1997). Puerperal inversion of the uterus in Nepal: case reports and review of literature. J Obstet Gynaecol Res. 23 (3): 319-325. https://doi.org/10.1111/j.1447-0756.1997.tb00852.x; PMid:9255049
Deneux-Tharaux C, Sentilhes L, Maillard F, Closset E, Vardon D, Lepercq J, Goffinet F. (2013). Effect of routine controlled cord traction as part of the active management of the third stage of labour on postpartum haemorrhage: multicentre randomised controlled trial (TRACOR). BMJ. 346: f1541. https://doi.org/10.1136/bmj.f1541; PMid:23538918 PMCid:PMC3610557
Goncalves ER, Bezerra LRPS, Karbage SAL, Rocha AP. (2016). Inversão uterina não puerperal em paciente jovem por mioma parido gigante: relato de caso e revisão de literatura. Rev Med UFC. 56 (2): 58-62. https://doi.org/10.20513/2447-6595.2016v56n2p58-62
Hostetler DR, Bosworth MF. (2000). Uterine inversion: a life-threatening obstetric emergency. J Am Board Fam Pract. 13 (2): 120-123. https://doi.org/10.3122/15572625-13-2-120; PMid:10764194
Hsieh TT, Lee JD. (1991). Sonographic findings in acute puerperal uterine inversion. J Clin Ultrasound. 19 (5): 306-309. https://doi.org/10.1002/jcu.1870190511; PMid:1651349
Hu CF, Lin H. (2012). Ultrasound diagnosis of complete uterine inversion in a nulliparous woman. Acta Obstet Gynecol Scand. 91 (3):379-381. https://doi.org/10.1111/j.1600-0412.2011.01332.x; PMid:22122794
Lipitz S, Frenkel Y. (1988). Puerperal inversion of the uterus. Eur J Obstet Gynecol Reprod Biol. 27 (3): 271-274. https://doi.org/10.1016/0028-2243(88)90133-5; PMid:3350199
Mihmanli V, Kilic F, Pul S, Kilinc A, Kilickaya A. (2015). Magnetic resonance imaging of non-puerperal complete uterine inversion. Iran Radiol. 12 (4): e9878. https://doi.org/10.5812/iranjradiol.9878v2
Miras T, Collet F, Seffert P. (2002). Acute puerperal uterine inversion: two cases. J Gynecol Obstet Biol Reprod (Paris). 31 (7): 668-671.
Morini A, Angelini R, Giardini G. (1994). Acute puerperal uterine inversion: a report of 3 cases and an analysis of 358 cases in the literature. Minerva Ginecol. 46 (3): 115-127.
Mwinyoglee J, Simelela N, Marivate M. (1997). Non-puerperal uterine inversions. A two case report and review of literature. Cent Afr J Med. 43 (9): 268-271.
Oboro VO, Akinola SE, Apantaku BD. (2006). Surgical management of subacute puerperal uterine inversion. Int J Gynaecol Obstet. 94 (2): 126-127. https://doi.org/10.1016/j.ijgo.2006.04.037; PMid:16777112
Occhionero M, Restaino G, Ciuffreda M, Carbone A, Sallustio G, Ferrandina G. (2012). Uterine inversion in association with uterine sarcoma: a case report with MRI findings and review of the literature. Gynecol Obstet Invest. 73 (3): 260-264. https://doi.org/10.1159/000334311; PMid:22377482
Sardeshpande NS, Sawant RM, Sardeshpande SN, Sabnis SD. (2009). Laparoscopic correction of chronic uterine inversion. J Minim Invasive Gynecol. 16 (5): 646-648. https://doi.org/10.1016/j.jmig.2009.06.001; PMid:19835813
Shepherd LJ, Shenassa H, Singh SS. (2010). Laparoscopic management of uterine inversion. J Minim Invasive Gynecol. 17 (2): 255-227. https://doi.org/10.1016/j.jmig.2009.12.003; PMid:20226420
Singh A, Ghimire R. (2020). A Rare Case of Chronic Uterine Inversion Secondary to Submucosal Fibroid Managed in the Province Hospital of Nepal. Case Rep Obstet Gynecol. 2020: 6837961. https://doi.org/10.1155/2020/6837961; PMid:32257475 PMCid:PMC7102445
Thomson AJ, Greer IA. (2000). Non-hemorrhagic obstetric shock. Baillieres Best Pract Res Clin Obstet Gynaecol. 14 (1): 19-41. https://doi.org/10.1053/beog.1999.0061; PMid:10789258
Vijayaraghavan R, Sujatha Y. (2006). Acute postpartum uterine inversion with haemorrhagic shock: laparoscopic reduction: a new method of management? BJOG. 113 (9): 1100-1102. https://doi.org/10.1111/j.1471-0528.2006.01052.x; PMid:16956343
Watson P, Besch N, Bowes WA Jr. (1980). Management of acute and sub-acute puerperal inversion of the uterus. Obstet Gynecol. 55 (1): 12-16.
Wendel PJ, Cox SM. (1995). Emergent obstetric management of uterine inversion. Obstet Gynecol Clin North Am. 22 (2): 261-274. https://doi.org/10.1016/S0889-8545(21)00179-0; PMid:7651670
Witteveen T, van Stralen G, Zwart J, van Roosmalen J. (2013). Puerperal uterine inversion in the Netherlands: a nationwide cohort study. Acta Obstet Gynecol Scand. 92 (3): 334-337. https://doi.org/10.1111/j.1600-0412.2012.01514.x; PMid:22881867
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Ukrainian Journal of Perinatology and Pediatrics
![Creative Commons License](http://i.creativecommons.org/l/by-nc/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “Ukrainian Journal of Perinatology and Pediatrics” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.