Uterine inversion is a rare obstetric complication in which the uterine fundus collapses into the uterine cavity spontaneously or during vaginal or cesarean delivery. It is potentially life-threatening as it is associated with postpartum hemorrhage with hypovolemic shock leading to maternal death if not diagnosed and treated promptly.
By definition, uterine inversion is the collapse of the uterine fundus through the endometrial cavity and the cervix. Although it is a rare postpartum complication with a reported incidence varying between 1 in 2000 to 1 in 50,000 live births , it can also occur spontaneously in patients with uterine cavity tumors like leiomyoma, teratoma, and sarcoma   .
Based on the time when it occurs, it is classified as either acute inversion i.e. occurring prior to cervical ring contraction; or subacute inversion i.e. occurring after contraction of the cervical ring or chronic inversion i.e. occurring more than four weeks postpartum     .
It is also classified based on the location of the uterine fundus as:
Incomplete inversion: i.e. the inverted uterine fundus lies within the endometrial cavity but does not extend beyond the external os.
Complete inversion: i.e.the inverted uterine fundus extends beyond the external os .
Prolapsed inversion: the inverted uterine fundus extends beyond the vaginal introitus .
Total inversion: in this the uterine fundus, as well as the vaginal wall are inverted. This type is seen in non-pregnant uteri in the presence of tumors .
The typical presentation of uterine inversion is excessive postpartum hemorrhage with hypovolemic shock. Unless diagnosed and treated promptly, the condition is associated with maternal mortality in some cases . Uterine inversion has been reported to be associated with several risk factors involving the traction on the umbilical cord, placenta accreta , large fetus and congenital uterine abnormalities  .
Entire Body System
Intravenous administration of oxytocin to trigger contractions and stop the uterus from inverting again. Emergency hysterectomy (surgical removal of the uterus) in extreme cases where the risk of maternal death is high. [web.archive.org]
The uterine inversion was successfully corrected at laparotomy after which an area of gangrene and perforation was noted on the uterine fundus. A decision to perform total abdominal hysterectomy was taken. [ncbi.nlm.nih.gov]
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. [ncbi.nlm.nih.gov]
The remainder of the steps are similar to Hunt ingdon’s method. Once the uterus has been repositioned all incisions in the cervix, uterus and vagina are closed with interrupted sutures. [intjmedsc.com]
[…] and section through endomyometrium showed dense chronic inflammation with necrosis. [omicsonline.org]
Severe Abdominal Pain
CASE: An adolescent nullipara with prolonged vaginal bleeding, severe abdominal pain, symptomatic anemia, and a presumed diagnosis of retained products of conception was found to have a large mass in the vagina. [ncbi.nlm.nih.gov]
Severe abdominal pain Sudden cardiovascular collapse Differential diagnosis: Uterovaginal prolapse Severe uterine atony Retained placenta without inversion fibroid polyp Postpartum collapse Neurogenic collapse Coagulopathy 5.2 MANAGEMENT The key to a [intjmedsc.com]
A lump in the vagina Abdominal tenderness Absence of uterine fundus on abdominal palpation and a polypoidal red mass in the vagina with placenta attached. [intjmedsc.com]
She was diagnosed as a case of neglected subacute incomplete uterine inversion. Both greyscale and Doppler sonographic and MR features of the case are described with an emphasis on better delineation of uterine and adnexal anatomy on MR imaging. [ncbi.nlm.nih.gov]
The use of Bakri balloon in management of severe post partum hemorrhage due to neglected uterine inversion in a HIV positive patiente. Int journal of gynec obst. 2012; S 119S3: 531-S867. PubMed Google Scholar Uzoma A, Ola B. [panafrican-med-journal.com]
Uterine inversion is an emergency requiring rapid diagnosis and prompt treatment to prevent maternal mortality. The diagnosis is based on the clinical presentation and findings on pelvic examination. Profuse vaginal bleeding, the absence of uterine fundus on abdominal examination, and hypovolemic shock with severe hypotension are clues to the diagnosis  . On pelvic examination in patients with complete inversion, the inverted fundus can be palpated at the cervical os or the vaginal introitus while the uterine fundus can be palpated in the lower part of the uterine segment or cervix in incomplete inversion. If the patient is hemodynamically stable and clinical diagnosis is inconclusive then the diagnosis can be made with ultrasonography. Uterine inversion appears as a vaginal mass with endometrial echogenicity in the shape of the letter C and uterine echogenicity in the shape of the letter H on ultrasound . Magnetic resonance imaging can also be performed and has more conspicuous findings compared to ultrasonography . Supportive workup may be required (if not already done for parturition) and includes complete blood count, blood grouping, cross-matching, serum electrolytes and blood chemistries.
Early diagnosis and treatment are essential, but diagnosis of this is not simple. This is a report of unusual case of complete uterine inversion diagnosed by accurate ultrasound leading to prompt potentially life-saving treatment. [ncbi.nlm.nih.gov]
Treatment options Treatment options vary, depending on the individual circumstances and the preferences of the hospital staff, but could include: Attempts to reinsert the uterus by hand. [web.archive.org]
The duration of time elapsed from moment of diagnosis to that of correction, along with rapid resuscitation measures are of utmost importance in its prognosis. [ncbi.nlm.nih.gov]
Death can occur quickly if the condition is not recognised. [ 4 ] Prognosis The condition carries a good prognosis if managed correctly. [patient.info]
In this two-year study we determine the incidence of this complication and we describe associated risk factors to expose its etiology. [ncbi.nlm.nih.gov]
Uterine Inversion/surgery Hysterectomy, Vaginal/instrumentation Hysterectomy, Vaginal/methods Leiomyoma/complications Leiomyoma/diagnosis Leiomyoma/surgery Uterine Inversion/physiopathology Uterine Inversion Abdominal Pain/complications Abdominal Pain/etiology [pesquisa.bvsalud.org]
Etiology Forced inversion is caused by excessive pulling of the cord or vigorous manual expression of the placenta or clots from an atonic uterus. [rnpedia.com]
Their etiology in order of frequency was submucus leiomyoma (71.6%), endometrial carcinoma (6.8%) and unspecified etiology (8%). [casereports.in]
The exact etiology of this complication still remains unclear. [jemds.com]
الصفحة 47 - Health care organizations should maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic [books.google.com]
It very rarely occurs in non-pregnant patients, when it is usually associated with prolapsing uterine fibroids or other benign pathologies, although in 15% the cause is a malignant tumour. [ 1 ] Epidemiology Incidence varies widely from as many as 1 per [patient.info]
Based on the clinical findings, epidemiological profile, physical examination, and previous histopathological results, the patient was treated with a total dose of 40 mg/m² cisplatin and four fractions of 180 cGy radiotherapy. [pagepress.org]
[…] else fails Oxytocic are given such as ergometrine, oxytocin or prostaglandins Antibiotics are started, uterine stimulants continued, closely monitor the patient after repositioning the uterus to prevent a re-inversion References: Uterine Inversion : Epidemiology [medicalfoxx.com]
Pathophysiology The inverted uterus is unable to restore normal position or contract appropriately. The woman is placed at increased risk for bleeding and infection. [rnpedia.com]
Learning objectives: • To understand the pathophysiology. • To understand and to be able to evaluate critically the general management principles. [doi.org]
Abstract Uterine compression suture to prevent impending recurrence of uterine inversion after laparotomy repositioning has not been reported previously. A 28-year-old primigravid woman demonstrated uterine inversion. [ncbi.nlm.nih.gov]
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