Acute Inversion of Uterus in Obstetrics.

Uterine inversion is an uncommon and unpredictable but potentially life threatening obstetric emergency. The typical presentation is that of severe postpartum haemorrhage and shock along with a mass either felt in the vagina or protruding outside the introitus. Early recognition and prompt management (by teamwork) by simultaneous correction of shock and repositioning of the inverted uterus are imperative in order to minimize the potential for maternal morbidity and mortality. There is a need for skills and drills training because of the rarity of acute inversion. Here is a present a case report of acute inversion of uterus following vaginal delivery and its management. The accompanying review of the literature provides helpful insights into the diagnosis and optimal management of this potentially life threatening condition.

Evaluation of the risk factors affecting pelvic floor relaxation

Pelvic relaxation is a common complaint in women admitted to gynecology clinics, with a prevalence of about 50% in the US. In this study, our goal was to identify factors which may contribute to the development of pelvic floor disorders. We conducted a case-control study, with cases selected from all the women who admitted to a gynecology clinic in Mashhad over a four month period. 100 cases who had some type of pelvic floor disorder were studied and compared with 100 controls without any pelvic problem. Each patient filled a questionnaire. Data was analyzed by SPSS, using chi-squared, t-test and logistics regression. P-value < 0/05 was considered as significant. Compared with controls, cases were more likely to have a higher body mass Index [27.6 +/- 3.7 v.s 23.9 +/- 3.7, P<0.001], to be younger at first delivery [18.5 +/- 3.1 v.s 19.7 +/- 3.5, P=0.01], and to have more parity [4.1 +/- 2.9 v.s 2.1 +/- 1.2, P< 0.001]. 14% of cases had a history of gynecology surgery versus 3% of controls [P=0.005], and 12% of cases had a history of operative vaginal delivery versus 2% of controls [P<0.006]. 26% of women who had pelvic organ prolapse had a history of macrosomic infant [weight >/= 4kg], while only 5% of controls had this history [P<0.001]. There were no significant differences in occupation and type of delivery between cases and controls. In our study, difficult delivery, operative vaginal delivery, and history of bearing a macrosomic infant were significantly associated with subsequent development of pelvic floor disorders

Macrosomia maternal features and perinatal complications

In a 10-year retrospective study of 165 pregnancies that resdulted in the delivery of infants weighing 4500 gm or more, an increased incidence of maternal and perinatal complications was noted. Women delivering macrosomic infants were of higher parity, more obese and more frequently hypertensive. Clinical diabetes was present in 10[6%]. We found that macrosimia occurred in 0.76% of all deliveries with male to female ratio of 2:1. The major maternal complications were shoulder dystocia 22.4% and postpartum hemorrhage 6.6%. Perinatal mortality was 11[66/1000]. Of the infants who survived, 25 were depressed at birth and seven developed Erb's Palsy