Uterine inversion: a shocking aftermath of mismanaged third stage of labour

Authors

  • Seema Dwivedi Department of Obstetrics and Gynecology, G.S.V.M. Medical College, Kanpur, India
  • Neena Gupta Department of Obstetrics and Gynecology, G.S.V.M. Medical College, Kanpur, India
  • Anshu Mishra Department of Obstetrics and Gynecology, G.S.V.M. Medical College, Kanpur, India
  • Shefali Pande Department of Obstetrics and Gynecology, G.S.V.M. Medical College, Kanpur, India
  • Pavika Lal Department of Obstetrics and Gynecology, G.S.V.M. Medical College, Kanpur, India

Keywords:

Inversion, Puerperal, Uterus

Abstract

Background: To study the incidence, causes, clinical presentations, management and maternal morbidity and mortality associated with acute puerperal inversion of uterus.

Methods: This retrospective study was conducted in Department of Obstetrics and Gynecology, G.S.V.M. Medical College, Kanpur, from March 2008 to March 2013. All the women who developed acute puerperal inversion of uterus either in or outside our hospital were included in the study.

Results: Majority of women presenting with inversion belonged to age group 20-35 years, were multigravida (68.2%), came from rural set-up (81.4%) and were unbooked (81.8%). Majority of deliveries complicated by inversion took place at home (50%), delivered by dais (46%). Mismanaged 3rd stage of labour proved to be an important factor (36.4%) leading to inversion uterus followed by atonicity of uterus. 90% of women suffered due to delay in management at PHC and CHC, 68%women succumbed to delay in diagnosis at the place of delivery by untrained staff, whereas 45% women suffered due to delay in transport facility. 13.63% women suffered from sepsis in post-operative period, 22.72% from renal failure whereas 18.18% died.

Conclusion: Proper education and training regarding active management of third stage of labour, diagnosis and management of uterine inversion should be imparted to traditional birth attendants, so that this potentially life-threatening obstetric emergency could be averted.

References

Hussain M, Jabeen T, Liaquat N, et al. Acute puerperal uterine inversion. J Coll Physicians Surg Pak 2004 Apr;14(4):215-7.

Hostetler DR, Bosworth MF. Uterine inversion: a life-threatening obstetric emergency. J Am Board Fam Pract. 2000 Mar-Apr;13(2):120-3.

Calder AA. Emergencies in operative obstetrics. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000 Feb;14(1):43-55.

Thomson AJ, Greer IA. Non-hemorrhagic obstetric shock. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000 Feb;14(1):19-41.

Wendel PJ, Cox SM. Emergent Obstetric management of uterine inversion. Obstet Gynecol Clin North Am. 1995 Jun;22(2):261-74.

Salomon CG, Patel SK. Computed tomography of chronic nonpuerperal uterine inversion J Comput Assist Tomogr 1990;14:1024-6.

Lewin JS, Bryan PJ. MR imaging of uterine inversion. J Comput Assist Tomogr 1989;13:357-9.

Cunningham FG, MacDonald PC, Gant NF, et al. Williams obstetrics. 20th ed. Stamford, Conn: Appleton & Lange, 1997:767-9.

Shah-Hosseini R, Evrard JR. Puerperal uterine inversion. Obstet Gynecol 1989;73: 567-70.

Johnson AB. A new concept in the replacement of the inverted uterus and a report of nine cases. Am J Obstet Gynecol. 1949 Mar;57(3):557-62.

Ogueh O, Ayida G. Acute uterine inversion: a new technique of hydrostatic replacement. Br J Obstet Gynaecol 1997;104:951-2.

Antonelli E, Irion O, Tolck P, Morales M. Subacute uterine inversion: description of a novel replacement technique using the obstetric ventouse. BJOG. 2006 Jul;113(7):846-7.

Uzoma A, Ola B. Complete Uterine Inversion Managed with a Rusch Balloon Catheter. JMC. 2010;1(1):8-9.

Downloads

Published

2016-12-10

Issue

Section

Original Research Articles