Uterine Inversion definition: Uterine inversion is a rare life threatening complication occurring in the third stage of labor in which the uterus turns inside out, the fundus prolapsing through the cervix.
There are three degrees of uterine inversion.
First degree – Dimpling of the fundus which still remains above the level of Internal OS.
Second degree – Fundus passes through cervix and lie inside the vagina.
Third degree – Entire Uterus turns inside out and hang out side the vagina.
Uterine inversion seen in two forms:
1. Acute
2. Chronic
1. Acute Inversion:
Extremely rare, Life threatening complication of third stage of labor in which uterus turns inside out either partially or completely.
Incidence 1 in 2,500 deliveries. Causes :
Around 80% cases occur due to faulty management of third stage of labor and 20% cases are spontaneous.
Predisposing factors are
(a) Incompletely separated placenta.
(b) Atonic Uterus
(C) Short Cord
(d) Fundal fibroid
(e) Precipitate labor.
(f) Associated with fundal attachment of placenta.
(g) Placenta accreta etc.
Risks of Inversion:
- Post partum hemorrhage – especially after detachment of the placenta.
-Shock – is disproportionate to the blood loss.
Is of neurogenic in origin due to traction on the infundibulo pelvic ligament, peritonium and broad ligament, stimulating the parasympathetic system & cervical distention.
-Puerperal sepsis – Various therapeutic measures adopted to reduce the inversion may aggravate the sepsis.
-Anuria and sheehan's syndrome – associated with shock.
Diagnosis:
Symptoms: Severe lower abdominal pain with bearing down sensation. Signs :
1) Varying degrees of Shock.
2) Abdominal examination shows cupping or dimpling of fundal surface.
3) Bimanual examination: to confirm the diagnosis & degree of inversion.
Prognosis: Prognosis is poor if not replaced immediately, death may occur due to shock, hemorrhage and pulmonary embolism.
Even if the patient survives, infection, sloughing of the uterus etc may lead to chronic inversion.
There are three degrees of uterine inversion.
First degree – Dimpling of the fundus which still remains above the level of Internal OS.
Second degree – Fundus passes through cervix and lie inside the vagina.
Third degree – Entire Uterus turns inside out and hang out side the vagina.
Uterine inversion seen in two forms:
1. Acute
2. Chronic
1. Acute Inversion:
Extremely rare, Life threatening complication of third stage of labor in which uterus turns inside out either partially or completely.
Incidence 1 in 2,500 deliveries. Causes :
Around 80% cases occur due to faulty management of third stage of labor and 20% cases are spontaneous.
Predisposing factors are
(a) Incompletely separated placenta.
(b) Atonic Uterus
(C) Short Cord
(d) Fundal fibroid
(e) Precipitate labor.
(f) Associated with fundal attachment of placenta.
(g) Placenta accreta etc.
Risks of Inversion:
- Post partum hemorrhage – especially after detachment of the placenta.
-Shock – is disproportionate to the blood loss.
Is of neurogenic in origin due to traction on the infundibulo pelvic ligament, peritonium and broad ligament, stimulating the parasympathetic system & cervical distention.
-Puerperal sepsis – Various therapeutic measures adopted to reduce the inversion may aggravate the sepsis.
-Anuria and sheehan's syndrome – associated with shock.
Diagnosis:
Symptoms: Severe lower abdominal pain with bearing down sensation. Signs :
1) Varying degrees of Shock.
2) Abdominal examination shows cupping or dimpling of fundal surface.
3) Bimanual examination: to confirm the diagnosis & degree of inversion.
Prognosis: Prognosis is poor if not replaced immediately, death may occur due to shock, hemorrhage and pulmonary embolism.
Even if the patient survives, infection, sloughing of the uterus etc may lead to chronic inversion.
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