ACUTE INVERSION OF

THE UTERUS
ACUTE INVERSION OF THE
UTERUS
 DEFINITION:
The uterus is partially or completely turned
inside out after delivery of the neonate.
 INCIDENCE:
1:2500-6500.
ETIOLOGY
A relaxed uterus including the lower uterine segment and cervix,
plus
 Induced:
– Vigorous pressure on the fundus (a complication of
Crede’s method).
– Traction on the cord especially if the placenta is
abnormally adherent.
– during manual removal of the placenta (can also occur
during CS).
 Spontaneous:
1. Precipitate labor.
2. Traction by the fetus on a very short cord.
3. Submucous fundal fibroid.
4. Vigorous straining or coughing.
DEGREES
 Ist degree:
The fundus is depressed but does not pass
through the cervix.
 2nd degree:
The fundus protrudes through the cervix.
 3rd degree:
All the uterus is inverted, dragging on the
vagina and protruding outside the vulva
CLINICAL PICTURE
 Symptoms:
Pain in lower abdomen, vaginal bleeding (usually massive),
symptoms of shock and mass protruding from the vulva in 3rd
degree cases.
 Signs:
1. Profound shock due to massive blood loss.
Traction on the peritoneum and adnexa may
also contribute.
2. Abdominally: cupping of the fundus in 1st and
2nd degree cases and absent uterus in 3rd
degree cases.
3. Vaginally: a soft purple mass is felt in the
vagina (in 2nd degree cases) or seen at the
vulva (in 3rd degree cases).
 TREATMENT
 Prophylaxis:
Avoid vigorous manipulations on a lax uterus or
traction on the cord of an abnormally adherent
placenta.
 Definitive treatment:
1. Two wide-bore IV cannulas are inserted. Blood sample
is sent for cross-matching. Ringer’s lactate IV infusion
is started. Plasma substitutes can be also used. The
inverted uterus is replaced in the vagina.
2. Under general anesthesia (preferably halothane to
relax the uterus), the inverted uterus is repositioned
manually with the palm of the hand and the fingers in
the direction of the long axis of the vagina. Tocolytic
drugs as terbutaline, ritodrine or magnesium sulfate
can be used to relax the uterus to facilitate reposition.
 TREATMENT
 Definitive treatment:
1. If the placenta is still attached, it is removed
to facilitate reposition of the uterus.
2. When normal uterine configuration is
restored, the tocolytic agent is stopped and
syntocinon infusion is started while
maintaining the uterus in position till it
contracts.