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Acute Puerperal Inversion of the Uterus — An Obstetric Emergency
Author(s) -
Rachagan S.P.,
Sivanesaratnam V.,
Kok K.P.,
Raman S.
Publication year - 1988
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1988.tb01606.x
Subject(s) - uterine inversion , medicine , fundus (uterus) , uterus , retained placenta , placenta , obstetrics , inversion (geology) , surgery , pregnancy , fetus , geology , seismology , tectonics , biology , genetics
EDITORIAL COMMENT: This paper carries the important messages about acute inversion of the uterus. Firstly do not pull on the umbilical cord unless the uterine fundus is contracted and palpable — it is the abdominal, not the cord‐pulling hand, that provides the ‘control’ in delivery of the placenta by controlled cord traction. Likewise the traction should not be excessive — if the placenta does not quickly deliver, pass a catheter, and the miracle occurs (and so it seems, so prompt is the response, even though it is an everyday experience), the placenta no longer being imprisoned either in uterine fundus, or lower segment by cervical oxytocin‐induced contraction. The second message is to replace the inverted uterus as soon as it is diagnosed and before removing the placenta if it is still attached — this gives a firmer ‘fundus' for the fist to push against after general anaesthesia relaxes the uterus for correction of the inversion. With incomplete inversion (11 of the 15 cases in this report) the placenta has usually been delivered by strong (? too strong) controlled cord traction and the dimple in the still palpable uterine fundus has not been noted — the inversion is felt in the upper vagina like a large broad‐based endocervical polyp when vaginal examination is performed because of postpartum haemorrhage. In the editor's experience of one such case the inversion was rapidly manually corrected once the uterus was relaxed by halothane, with immediate cessation of haemorrhage. Summary: Over a 17‐year period, 15 patients with acute puerperal inversion of the uterus were managed at the University Hospital, Kuala Lumpur, an incidence of 1 in 4,836 delveries. Injudicious traction on the umbilical cord before the uterus was well contracted, was probably the most important causative factor. Haemorrhage was more severe when removal of the placenta was done prior to correction of the inversion. Either the hydrostatic method or manual replacement were used but more often a combination of both techniques was found necessary. With careful management of the third stage of labour, this complication can be avoided.