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PubMed2005

[Non-puerperal uterine inversion. Report of a case].

Non-puerperal uterine inversion is extremely rare. We report a case associated with leiomyoma. It is presented the case of a multiparous of 46 year-old for presenting severe vaginal bleeding, pelvic pain and strange body vaginal sensation. The diagnosis was uterine myoma in abortive phase. An abdominal hysterectomy was performed to find a complete uterine inversion. This report represents an anecdotal case of non-puerperal uterine inversion successfully treated surgically.

Female↗
PubMed2002

Acute uterine inversion: a review of 40 cases.

OBJECTIVE: To determine the incidence, complications, and risk of recurrence of acute uterine inversion. METHODS: A retrospective chart review was conducted of all cases of acute uterine inversion recorded at the Grace Maternity Hospital in Halifax, Nova Scotia, from 1977 to 2000. RESULTS: During the 24-year period studied, 40 cases of acute uterine inversion occurred following 125,081 births. The incidence of acute uterine inversion following vaginal birth was 1 in 3737, and following Caesarean section, 1 in 1860. Post-partum hemorrhage complicated 65% of cases of acute uterine inversion, and 47.5% required blood transfusion. There was no recurrence in 26 subsequent deliveries. Following the institution of active management of the third stage of labour in 1988, the incidence of acute uterine inversion following vaginal delivery fell 4.4-fold. CONCLUSION: Acute uterine inversion is rare but accompanied by high risk of postpartum hemorrhage and the need for blood transfusion. Active management of the third stage of labour may reduce the incidence of uterine inversion.

Blood Transfusion↗
PubMed2001

[Acute complete uterine inversion--care report].

OBJECTIVES: Acute puerperal uterine inversion is a rare but very feared obstetrical complication. It determines an almost immediate shock and serious metrorrhagia. It is a introflexion of parietes uteri which takes place during the third stage of labor or during the first hours of puerperium. It can be distinguished in inversion of I, II or III degree according to the zone concerned by the introflexion: only the fundus of the uterus, all the corpus emerging in the vagina or the entirety of the uterus coming out from the vulvar orifice. RESULTS: This is report a case of inversion of the uterus during third stage of labor in multiparous aged 24 years admitted to Department of Gynecology & Obstetric in Hospital of Słupsk. The uterine III degree inversion was spontaneous during third stage of labor and was immediately diagnosed. Manual manipulation was attempted immediately to reverse the inversion but it was not successful. Because patient fell in cardiovascular shock she was resusciated and the inverted uterus repositioned using Huntington's method under general anaesthesia. After intra-abdominal repositioning of the uterus the placenta was removed manually and intramural injection of oxitocine was done to avoid immediate relapse. Whole obstetrical procedure was carried out within one-half hour after inversion. CONCLUSIONS: Although uncommon, in left unrecognized, uterine inversion will result in severe hemorrhage and shock, leading to maternal death. Manual manipulation should be attempted immediately to reverse the inversion. In the most resistant of inversions, surgical correction might be required. Following inversion of the uterus, further normal pregnancies can be expected.

Acute Disease↗
PubMed2005

Non-puerperal uterine inversion associated with endometrial carcinoma--a case report.

BACKGROUND: Non-puerperal uterine inversion is rare, and a case associated with endometrial carcinoma is even rarer. It is difficult to diagnose the condition preoperatively and most cases are diagnosed at surgery. CASE: We describe a case of uterine inversion associated with endometrial carcinoma. Initially, the patient was thought to have a cervical adenocarcinoma and treated with chemotherapy; however, a diagnosis of uterine inversion was made with magnetic resonance imaging (MRI) and ultrasonography during pre-surgical chemotherapy. We performed total abdominal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy. CONCLUSION: MRI and ultrasonography can be extremely useful tools for diagnosing uterine inversion.

Endometrial Neoplasms↗
PubMed2004

Acute puerperal uterine inversion.

OBJECTIVE: To determine the frequency, causes, clinical presentations, management and maternal mortality associated with acute puerperal inversion of the uterus. DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: The Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre (JPMC), Karachi, over eight years period from 1st January 1995 to 31st December 2002. MATERIALS AND METHODS: All the patients who developed acute puerperal inversion of the uterus either in or outside the JPMC were included in the study. Patients of chronic uterine inversion were not included in the present study. Abdominal and vaginal examination was done to confirm and classify inversion into first, second or third degrees. RESULTS: 57036 deliveries and 36 acute uterine inversions occurred during the study period, so the frequency of uterine inversion was 1 in 1584 deliveries. Mismanagement of third stage of labour was responsible for uterine inversion in 75% of patients. Majority of the patients presented with shock, either hypovolemic (69%) or neurogenic (13%) in origin. Manual replacement of the uterus under general anaesthesia with 2% halothane was successfully done in 35 patients (97.5%). Abdominal hysterectomy was done in only one patient. There were three maternal deaths due to inversion. CONCLUSION: Proper education and training regarding placental delivery, diagnosis and management of uterine inversion must be imparted to the maternity care providers especially to traditional birth attendants and family physicians to prevent this potentially life-threatening condition.

Acute Disease↗
PubMed1994

[Acute puerperal uterine inversion: a report of 3 cases and an analysis of 358 cases in the literature].

Acute puerperal uterine inversion is a rare but very feared obstetrical complication. It determines an almost immediate shock and serious metrorrhagia. It is a "glove-finger" introflexion of parietes uteri which takes place during the third stage of labor or during the first hours of puerperium. It can be distinguished in inversion of I, II or III degree according to the zone concerned by the introflexion: only the fundus of the uterus, all the corpus emerging in the vagina or the entirety of the uterus coming out from the vulvar orifice. The research carried out in the archives of the Department Obstetrics and Gynaecology of the University of Rome "La Sapienza" has showed, for the 20 years 1968-1988, 3 cases of uterine inversion out of a total of 69,677 childbirths. The uterine inversion was immediately diagnosed and in all the 3 cases a method of replacement by central taxis was practiced. In 2 cases, despite the packed tamponade, there was a recidivist or persistent uterine inversion of 1 degree, and in both cases a surgical reduction by laparatomy was practiced. In 1 of the 2 cases a hysterectomy was needed because of the persisting metratonia and metrorrhagia. The III case was treated with a manual replacement, a uterus massage from outside keeping the organ, with fist inside the cavity, in forced anteflexion in order to reach a good contractile activity. In 2 of the 3 cases the placental stage was operative, manual in 1 case and with fundal pressure applied abdominally in the other. We have found and analysed, in the international literature, 358 cases described from 1939 to 1989. The homogeneous data have been grouped in 21 tables for an easier visualization. Frequency varies from 1 out of 1,200 childbirths to 1 out of 57,393 childbirths. The medium value has been 1 out of 5,903 in the period from 1939 to 1989. The most significant data emerging from the analysis of the 358 cases of uterine inversion concern the placental stage. This was spontaneous in a number of cases equivalent to 28.9%; the number of fundal pressure applied abdominally was up to 30.9%; tractions over funicle up to 22.3%; manual delivery of the placenta up to 17.9%. Eighty-nine percent of cases were diagnosed by simple inspection, whilst for the resting ones an exploration was needed. For most of the cases the treatment was immediate (77%) especially by means of manual reduction vaginally (88%). Hysterectomy was needed for 14 cases that is up to 4.24%.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗
PubMed1995

[Complete non-obstetrical uterine inversion].

A rare case of a gynaecologic uterine inversion is reported emphasizing on the exceptional character of the gynecologic uterine inversion and the pathogenic problems which are tackled. Gynaecologic inversion results from a tumor implanted on fundus of the uterus or from the essential atrophy of suspension ligaments of the uterus. Treatment depends on the anatomic type and the stage.

Adult↗
PubMed2006

Puerperal uterine inversion: a report of four cases.

Acute puerperal uterine inversion is a life-threatening and unpredictable obstetric emergency. If overlooked, it could lead to a maternal death. Although the precise cause is unknown, it is postulated to be caused by the mismanagement of the third stage of labor with premature traction of the umbilical cord and fundal pressure before placental separation. At the Ipoh General Hospital in Malaysia there were 31 394 deliveries and four acute uterine inversions occurring from 1 January 2002 to 30 June 2005. The four patients were between 25 and 36 years of age and their parities were between two and three. When manual repositioning of the uterus failed, successful correction was accomplished by the O'Sullivan's hydrostatic method. One case had to undergo subtotal hysterectomy after repositioning because of massive hemorrhage secondary to placenta accreta. Early diagnosis, immediate treatment of shock, and replacement are essential.

Adult↗
PubMed2004

Chronic uterine inversion: preservation of the uterus--case report.

Uterine inversion is a rare and dangerous complication of labor. Although it can be reconstructed successfully with prompt intervention in acute stages, surgical interventions are usually mandatory in sub-acute or chronic phases. In this report we present a case of chronic uterine inversion, that was successfully treated with abdominal surgery.

Adult↗
PubMedDate not supplied

Uterine inversion by a mixed müllerian tumor of the corpus.

Mixed müllerian tumors (MMT) of the uterus have been reported following the use of tamoxifen. Rarely, these tumors lead to an uterine inversion. The surgical approach of a uterine inversion forms a therapeutic challenge. In this article, a case of uterine inversion due to a MMT is reported, together with a literature review regarding the developing mechanisms and management.

Aged↗
PubMed1996

Uterine inversion after nitroglycerin use during cesarean delivery.

Intravenous nitroglycerin was used to provide uterine relaxation for cesarean delivery of a macrosomic infant. The procedure was complicated by uterine inversion, and subsequent uterine atony. While several other factors may have contributed to the uterine atony, nitroglycerin administration might have played a role. Further, while nitroglycerin was helpful in facilitating the delivery of the macrosomic infant, the risk of uterine inversion must be considered.

Journal Article↗
PubMed1991

[Uterine inversion: an anesthetic emergency].

A case of complete uterine inversion, in a 27-year-old woman after delivery of her third child, is reported. Because of lack of placental separation after 40 min. manual removal was carried out under general anaesthesia (midazolam, ketamine, alfentanil). The placenta was quickly and easily removed, but followed immediately by protrusion of the uterine fundus at the vulva. Simultaneous, blood pressure became unmeasurable, and the patient became cyanosed. The uterus remained impossible to replace until anaesthesia had been deepened. The patient remained shocked despite intravenous fluids and catecholamines. As soon as the uterus was replaced, blood pressure rose to 80 mmHg. The patient was extubated 50 minutes later, blood pressure being 105/80 mmHg. Acute and subacute puerperal uterine inversion is a rare obstetrical emergency (1 in 20,000 deliveries) with a 15% mortality rate. Immediate recognition and early treatment to relax the cervico-uterine junction, should ensure rapid replacement of the uterus.

Adult↗
PubMed1991

[The treatment of obstetrical uterine inversion. Apropos of 3 cases].

Uterine inversion is exceptional and spectacular, although treatment is simple if diagnosed early. Three cases are reported with a review of possible obstetrical procedures for reduction. Manual repositioning by central pressure is emphasised. General anesthesia is generally needed because of associated state of shock. The three principal steps of manual reduction are: intra-abdominal repositioning of the uterus, removal of placenta, intramural injection of ocytocine to avoid immediate relapse. Ideally, obstetrical procedure should be carried out within one-half hour after inversion.

Adult↗
PubMed2006

Submucous myoma induces uterine inversion.

OBJECTIVE: Inversion of the uterus is indeed a rarity for a gynecologist. The puerperal variety is associated with pregnancy, including term pregnancy and abortion. The nonpuerperal condition may be tumor-induced or idiopathic. We present a nonpuerperal uterine inversion and discuss a reasonable plan for its management. CASE REPORT: A 42-year-old, unmarried woman without sexual experience and any systemic diseases noted a mass outside of the vaginal introitus combined with massive vaginal bleeding and abdominal pain of sudden onset after taking laxative agents for colonoscopic preparation. Then she had voiding difficulty with distended bladder. A suprapubic urinary catheter was inserted and 800 mL urine was drained out. The patient received emergency tumor resection and subtotal hysterectomy. The diagnosis of uterine inversion was confirmed during operation. The postoperative course was uneventful and she was discharged without complication. CONCLUSION: Nonpuerperal inversion of the uterus is rarely encountered by gynecologists. Diagnosis of uterine inversion is often not easy and imaging studies might be helpful. Surgical treatment is the method of choice in nonpuerperal uterine inversion.

Adult↗
PubMed2006

Embryonal rhabdomyosarcoma with uterine inversion: case report.

Presented here is a 16-year-old nulliparous girl who had embryonal rhabdomyosarcoma causing uterine inversion. She had been referred with a one year history of continuous vaginal bleeding and vaginal swelling. Histology had shown sarcoma botyroides and had received five courses of chemotherapy at the referring hospital. At surgery she was found to have uterine inversion and extended hysterectomy was carried out to be followed by radiotherapy.

Adolescent↗
PubMed2005

A case report of rhabdomyosarcoma of the uterus associated with uterine inversion.

BACKGROUND: Alveolar rhabdomyosarcoma is an uncommon malignant soft tissue tumor rarely found in the genital tract. This tumor is associated with a poor prognosis, especially in the adult population. Equally as rare are non-puerperal uterine inversions secondary to sarcomas. CASE: A 21-year-old obese woman was initially evaluated with excessive vaginal bleeding. On exam, a large pedunculated mass protruding from the cervix was seen and biopsy of this mass revealed an alveolar rhabdomyosarcoma. The patient was treated with adjuvant chemotherapy consisting of VAC (Vincristine, Actinomycin, and Cyclophosphamide) for a presumed cervical rhabdomyosarcoma. After five cycles of chemotherapy the patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, at which time a complete uterine inversion was noted with the tumor located at the fundus of the uterus. Final pathology showed alveolar rhabdomyosarcoma of the uterus. The patient then received additional postoperative VAC regimen for a total of 10 treatments and remains in good health with no evidence of disease 20 months from diagnosis. CONCLUSION: This case report describes the only reported case of uterine inversion secondary to alveolar rhabdomyosarcoma of the uterus and discusses current therapeutic options for adults.

Adult↗
PubMed1997

Use of sublingual glyceryl trinitrate as a supplement to volatile inhalational anaesthesia in a case of uterine inversion.

We present a case of uterine inversion in which glyceryl trinitrate was used via the sublingual route, as opposed to the intravenous route, in association with volatile inhalational anaesthesia in order to achieve relaxation of the uterus. A transient, but significant, hypotensive response occurred, which was easily corrected with a colloid infusion and vasopressors. Sublingual glyceryl trinitrate is easily administered, has a fast onset of action and may have a role in situations where rapid relaxation of the uterus is required.

Journal Article↗