1/24. Acute complete puerperal inversion of the uterus following twin birth: case report. A twenty-year old multiparous woman was admitted to our obstetric unit on February 13th 1998, with features of acute complete puerperal uterine inversion, two hours after twin birth at home. She was resuscitated and the inverted uterus repositioned using Johnson's method under general anaesthesia. The potential of twin birth as an important aetiological factor in acute/sub-acute puerperal inversion is discussed. Formal training of traditional birth attendants (TBAs) in developing countries where trained medical personnel are scarce, is emphasised. ( info) |
2/24. uterine inversion: a life-threatening obstetric emergency. BACKGROUND: Acute puerperal uterine inversion is a rare but potentially life-threatening complication in which the uterine fundus collapses within the endometrial cavity. Although the cause of uterine inversion is unclear, several predisposing factors have been described. maternal mortality is extremely high unless the condition is recognized and corrected. methods: medline was searched from 1966 to the present using the key phrase "uterine inversion." Nonpuerperal uterine inversion case reports were excluded from review except when providing information on classification and diagnostic techniques. A summarized case involving uterine inversion and a review of the classification, etiology, diagnosis, and management are reported. RESULTS AND CONCLUSIONS: Although uncommon, if left unrecognized, uterine inversion will result in severe hemorrhage and shock, leading to maternal death. Manual manipulation should be attempted immediately to reverse the inversion. Tocolytics, such as magnesium sulfate and terbutaline, or halogenated anesthetics may be administered to relax the uterus to aid in reversal. Intravenous nitroglycerin provides an alternative to the tocolytics and offers several pharmacodynamic advantages. Treatment with hydrostatic pressure may be attempted while waiting for medications to be administered or for general anesthesia to be induced. In the most resistant of inversions, surgical correction might be required. ( info) |
| Acute inversion of the uterus is a rare complication during cesarean section. We describe one such case in which diagnosis was made immediately and reversion was performed within few minutes. A high index of suspicion and prompt management can prevent further complications. ( info) |
4/24. Complete non-puerperial uterine inversion as a result of a uterine sarcoma. Complete non-puerperial uterine inversion is rare and when present is usually associated with a prolapsed submucous fibroid. The inversion in this case was associated with a uterine sarcoma in an 88 year old diabetic patient, gravida 13, who presented with a four month history of intermittent vaginal bleeding. She was successfully managed with a total abdominal hysterectomy and some of the difficulties with diagnosis and management are highlighted. ( info) |
5/24. uterine inversion caused by uterine sarcoma: a case report. uterine inversion caused by uterine sarcoma is a rare condition with 12 reported cases to date according to a medline search. We report two cases of this rare condition. A 71- and a 72-year-old woman presented with uterine sarcomas rapidly extruded into the vagina. In both cases, magnetic resonance imaging (MRI) scans showed U-shaped uterine cavities and the pedicles of these tumors were attached to the uterine fundi. Pathological examination confirmed a leiomyosarcoma and a heterologous carcinosarcoma. uterine inversion can occur when uterine sarcoma rapidly increases in size and extrudes into the vagina. MRI should be performed in the diagnosis of this rare combination. ( info) |
6/24. Acute uterine inversion due to a growing submucous myoma in an elderly woman: case report. A case of acute non-puerperal uterine inversion due to a growing submucous myoma in elderly woman is presented. This is rare and the diagnosis is often difficult. ( info) |
7/24. Non-puerperal uterine inversion in association with uterine sarcoma: clinical management. Non-puerperal uterine inversion due to uterine sarcoma is a rare entity often diagnosed at the time of surgery. patients may present with pelvic pain, vaginal discharge, or hemodynamic shock. Clinically, the diagnosis may be suspected if there is a large vaginal mass and difficulty in palpating the cervix. Four surgical procedures have been described to manage non-puerperal uterine inversion, two by the abdominal route and two by the vaginal route. The Haultain procedure performed abdominally is preferred for uterine sarcomas as it facilitates reversion of the uterus vaginally or excision of the pedicle and removal of the prolapsed tumor vaginally. We describe a patient with this condition managed by the Haultain procedure. ( info) |
8/24. Postmenopausal uterine inversion associated with endometrial polyps. BACKGROUND: Postmenopausal uterine inversion is an extremely rare gynecologic complication. We report a case of uterine inversion associated with endometrial polyps alone. CASE: A postmenopausal nullipara with a history of recurrent postmenopausal bleeding was evaluated for persistent vaginal bleeding. Benign endometrial polyps were found, and the patient's symptoms improved after a therapeutic dilation and curettage. She had acute onset of profuse vaginal bleeding 3 months later and a mass protruded from the cervix. A laparotomy revealed an inverted uterus that was resolved by the Haultain technique and was followed by total abdominal hysterectomy. CONCLUSION: Nonpuerperal uterine inversion associated with endometrial polyps was successfully treated surgically. ( info) |
| uterine inversion is an uncommon but life-threatening obstetric emergency. A review of the approaches to correct uterine inversion is presented. In cases where time has elapsed between delivery and presentation, the inversion ring may have become too tight to allow manual reposition of the fundus. In such cases, it has to be divided by a vertical incision. In subsequent pregnancy, antenatal care should include placental localization and planning for an elective Caesarean Section. The outcome of future pregnancies may be complicated by placenta accreta and massive haemorrhage. ( info) |
10/24. Inversion of the uterus at caesarean section. INTRODUCTION: Inversion of the uterus through the uterine incision during caesarean section is a rare event. Therapy is usually simple and maternal morbidity is low when re-inversion of the uterus can be accomplished immediately. In cases of prolonged uterine inversion thereof, haemodynamic instability and shock, often out of proportion to the degree of blood loss, have been reported as serious sequelae. CASE REPORT: We describe such a case with a prolonged inversion to re-inversion interval where the patient suffered an intraoperative cardiovascular arrest during unrepositioned uterine inversion. Reposition of the uterus led to an immediate return of the patient's vital signs and improvement of her haemodynamic status. DISCUSSION: The mechanisms of haemodynamic instability and the technical aspects of manual reduction of the inverted, heavily contracted uterus during caesarean section are discussed. ( info) |