Uterine Inversion (Postpartum)

Published on 31/05/2015 by admin

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Last modified 31/05/2015

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Chapter 225 Uterine Inversion (Postpartum)

INTRODUCTION

Description: Uterine inversion is the turning inside-out of the uterus immediately after delivery. Uncommon and often iatrogenic, this may be associated with catastrophic bleeding and cardiovascular collapse. (Rarely the condition has also been reported in nonpregnant patients with intrauterine pathology.)
Prevalence: One of 25,000 deliveries.
Predominant Age: Reproductive.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Iatrogenic (traction on the umbilical cord or downward pressure on the uterine fundus to facilitate delivery of the placenta); abnormalities of placentation (accreta, increta, percreta).
Risk factors: Uterine atony: multiparity (grand), uterine overdistention (multiple birth, polyhydramnios), prolonged labor, prolonged oxytocin stimulation, muscle-relaxant agents (MgSO4), rapid labor.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• A mass may be seen attached to or directly following the placenta as it delivers
• Bright-red vaginal bleeding
• Bradycardia from vagal stimulation
• Tachycardia, hypotension, and vascular collapse possible as a result of blood loss

DIAGNOSTIC APPROACH

Differential Diagnosis

• Uterine atony
• Retained placental fragments
• Genital tract lacerations
• Coagulopathy

Associated Conditions: Uterine atony, postpartum hemorrhage.

Workup and Evaluation

Laboratory: Hemoglobin or hematocrit to monitor status and volume of blood loss. (Acute loss may not be reflected by these measures until equilibration has occurred in 6 to 24 hours.)
Imaging: Ultrasonography may be used to verify the diagnosis, but this is unnecessary and delays the implementation of therapy.
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