Successful management of recurrent puerperal uterine inversion

Abstract

The puerperal uterine inversion is a rare and severe complication occurring in the third stage of labour. The exact mechanisms are unclear. However, extrinsic factors such as prolonged labour, umbilical cord traction, oxytocic use etc. have been mentioned. Other intrinsic factors such as primiparity, uterine hypotonia, different placental localizations, fundal location of a myoma or short umbilical cord have also been reported. The diagnosis of uterine inversion is mainly made on the basis of clinical symptoms which include haemorrhage, shock and a strong pelvic pain. The immediate treatment of the uterine inversion is required. A case of 23 years old, second gravida with one previous spontaneous first trimester abortion, who had a full term normal vaginal delivery but while trying to deliver the placenta after confirmation of placental separation clinically, uterine inversion was diagnosed immediately and manual repositioning of uterus was done under general anaesthesia. On the 6 th post natal day, during the routine postnatal rounds, uterus was not palpable per abdomen and a local examination revealed a mass at the introitus. A diagnosis of grade 3 sub-acute inversion was made and she was taken up for exploratory laparotomy. Reinsertion was done according to the Huntington technique by placing clamps on the round ligament, near its insertion on the uterus, and applying traction upwards while the assistant exerted traction on the contra lateral way through the vagina. As persistent atonicity and diffuse oozing was noted multiple Cho sutures were put over the uterus. Patient had an uneventful postnatal period. This is a rare scenario where the same patient had an acute inversion initially followed by sub-acute inversion.