Symptoms

Perforation of the uterus when a sound or other instrument is inserted

Fixed symptoms are usually present, caused by the lesion fiing the uterus are as follows

.Spasmodic dysmenorrhoea

.Pelvic congestion syndrome

After pregnancy involution may be slightly retarded.

.ow backache and pelvbic pain

Morelikely due to othoprodic case

.Rectal symptoms

Sizewd utavs cases no symp

Dyspareunia

May lead to bugldity & mealel dishesmony

.infertility

Cervix is directed forwards away from the seminal pool

Abortion

Physical signs

p/s

B/E

P/R

Before empty beadues is mandatory.

Differential iagnosis

.Acute aneflexion of cervix

A tubal or ovarian swelling prolapsed in the pounch

.Faeces or other mass in the lower bowel

.A tumour such as endometriosis in the pounchof Douglas or in the rectovaginal septum

pelvic haematocele and an abscess

A leimyoma or other tumour in the posterior wall of the uterus

Management and treatment

Very really necessary to ascertain mobility. EUA

PREvenTION

.Regular emptyin of the bladder to avoid over distension

.pelvic floor exercises

Early ambulation

Posture

Between the 10th-28th

Pessary treatment

REPLACEMENT OF THE UTERUS AND INSERTION OF A PESSARY

Principles of treatment

Asupporting pessary inserted into the upper vagina will hold the uterus in normal
position temporily

But it cannot cure a retrodisplacement except possibily in the puerium the pessay tension
on the posterior vaginal fornix and the overlying uterosacral ligament and this in turn
holds the cervix backwards.

OPERATIVE TREAMENT FOR RETRODISPLACEMENT

-when the displacement has been casing symptoms by an adequately conroled

pessary test.

-in a few cases of infertility and habitual abortion .

RETROVERTED GRAVID UTERUS

The uterus during the early weeks in 15 per cent of all pregnancies

Impaction of the pregnant uterus is most likely to occur when the pelvis is small and has
an overhanging sacral promontory

Diagnosis

Treatment

Colapse vessels rupture.

The bladder is kept empty continuours drainage and large-sized pessary is inserted the
vagina

INVERSION OF THE UTERUS

Inversion is a condition in which the uterus turns iniside out the fundus
prolapsingthrough the cervix

Acute inversion

This occurs during or immedialety after the third stage of labour the cervix is open end
atonic and the fundus passes through it because of

..masmanagement of third stage of labour

..pressure on the fundus by the attendant

..traction on the umbilical cord of an unseparated placenta

Replacement of the uterine fundus under gentral anaesthesia fakes precence over
resuscitation.

Chronic inversion

Puerperal

Pathology

Clinical features

Discharge and irregular bleeding dating from a confinement

Haemorrhage or obstetric shock other symptoms are low backache and chronic pelvic
pain

On examination ,an infected haemorrhagic mass is found in the vagina and likely to be
confused with a sloughing polyp

A retained portion of placent

In ulcerated prolapsed cervix and even a malignant neoplasm.

Treatment

SENILE INVERSION

INVERSION DUE TO PEDUNCULATED TUMOUR

The patient’s symptoms are those of the polyp and the associated inversion may be
missed the possibility is kepttt in mind.