Inside out: A successful repositioning of a chronic third-degree uterine inversion / Philippine Journal of Obstetrics and Gynecology

@#In this day and age, with the advancement of treatments and the strong campaign to discourage home deliveries, chronic uterine inversion is now considered an uncommon but life-threatening obstetric condition. In this report, we present a case of a 17-year-old primipara, who sought consultation due to prolonged and heavy vaginal bleeding. Upon speculum examination, a knob-like, fleshy, hyperemic, smooth mass, approximately 6 cm × 5 cm × 4 cm, was seen occupying the upper third of the vaginal canal. On internal examination, a globular mass was felt protruding through the cervix, which bleeds easily on manipulation. Uterine corpus was neither appreciated on both abdominal and rectovaginal examination. The patient was admitted and managed as a case of chronic uterine inversion, which was further confirmed by a sonogram. Successful repositioning of the uterus was achieved after trying different established techniques and procedures in the attempts at maneuvering the chronically inverted uterus.

Uterine inversion associated with malignancy – A challenge in surgical management: A case report / Philippine Journal of Obstetrics and Gynecology

@#Uterine inversion is a rare clinical problem. Most cases of uterine inversions are puerperal inversions wherein it is encountered as an obstetric emergency, and sometimes a diagnostic challenge in gynecology. Uterine inversions associated with malignancies such as endometrial carcinoma and sarcoma are even rare. We report 2 cases of this rare condition. A 55 year old diagnosed with endometrial carcinoma and a 60-year-old woman diagnosed with sarcoma (malignant mixed mullerian tumor) presented with mass protruding from the vaginal introitus. The diagnosis of complete uterine inversion was confirmed in both cases during laparotomy. Total abdominal and vaginal hysterectomy and bilateral salpingo-oophorectomy, bilateral pelvic lymph node dissection, paraaortic lymph node sampling was done. It required a challenging surgical procedure to remove the tumor along with the review of literature especially of its association with malignancies.

Non-puerperal uterine inversion associated with myomatosis

SUMMARY Uterine inversion is an uncommon complication of the puerperium and it is an even rarer complication of the non-puerperal period. In this way, uterine inversions are classified into two groups, being of puerperal origin due to obstetric problems and non-puerperal origin due to gynecological problems. In general, a non-puerperal uterine inversion occurs as a possible complication of a sub mucosal leiomyoma, after an expansive process, a dilation of the cervix occurs and thus its protuberance over the vaginal canal.

RESUMO A inversão uterina é uma complicação incomum do puerpério e é uma complicação ainda mais rara do período não puerperal. Dessa forma, as inversões uterinas são classificadas em dois grupos, sendo as de origem puerperal decorrentes de problemas obstétricos e as inversões de origem não puerperal decorrentes de problemas ginecológicos. Em geral, a inversão uterina não puerperal decorre como uma possível complicação de um leiomioma submucoso — após o processo expansivo, ocorre a dilatação do colo uterino e, dessa forma, a sua protusão sobre o canal vaginal.

The role of sonography in the diagnosis of chronic puerperal uterine inversion: A case report / Philippine Journal of Obstetrics and Gynecology

Chronic puerperal uterine inversion is a rare and life-threatening obstetric emergency which requires emergent treatment. We present a case of a 27-year-old Gravida 2 Para 2 (2002) with chronic uterine inversion. A bleeding, 4 x 4 x 5 cm fleshy knob like mass protruding from the cervix, was seen during vaginal inspection. Two-dimensional transvaginal sonography and 3-dimensional imaging clinched the diagnosis of uterine inversion. The patient underwent Haultain's procedure and was discharged improved with resumption of normal menses. Postpartum transvaginal sonography revealed a normally positioned uterus.

The role of sonography in the diagnosis of chronic puerperal uterine inversion: A case report / Philippine Journal of Obstetrics and Gynecology

Chronic puerperal uterine inversion is a rare and life-threatening obstetric emergency which requires emergent treatment. We present a case of a 27-year-old Gravida 2 Para 2 (2002) with chronic uterine inversion. A bleeding, 4 x 4 x 5 cm fleshy knob like mass protruding from the cervix, was seen during vaginal inspection. Two-dimensional transvaginal sonography and 3-dimensional imaging clinched the diagnosis of uterine inversion. The patient underwent Haultain's procedure and was discharged improved with resumption of normal menses. Postpartum transvaginal sonography revealed a normally positioned uterus.

Inversión uterina puerperal subaguda grado II / Sub-Acute Puerperal Uterine Inversion Grade II

La inversión uterina obstétrica es una entidad rara, y una de las complicaciones más graves del tercer estadio del parto que pone en peligro la vida de la parturienta. La inversión del útero consiste en un cambio de disposición de sus paredes, la cara interna se convierte en externa y el órgano se invagina en forma de dedo de guante. Es un accidente obstétrico que constituye una verdadera emergencia y es causa de muerte materna por choque hemorrágico. Afortunadamente su incidencia en nuestro país es baja, dado por la escasa cantidad de reportes sobre el tema. El objetivo del trabajo es presentar este caso por la atipicidad en la forma clínica que se diagnosticó durante el puerperio. La paciente acudió al hospital a los 22 días de puerperio, se diagnosticó una inversión uterina puerperal subaguda grado II, se realizan maniobras encaminadas a la reducción manual de la inversión con resultados insatisfactorios. Fue necesario realizar histerectomía total abdominal; se logró conservar ambos anejos y la vida de la paciente. Su tratamiento habitualmente es quirúrgico, sobre todo si no se diagnostica en el tercer estadio del parto(AU)

Obstetric uterine inversion is a rare entity, and one of the most serious complications of the third stage of labor that endangers the life of the mother. The inversion of the uterus is a change of arrangement of its walls, it pulls on the inside surface, and turns the organ inside out shaping a glove finger. It is an obstetric accident which constitutes a true emergency and causes of maternal death from hemorrhagic shock. Fortunately its incidence in our country is low, given the low number of reports on the subject. The aim of this paper is to present this case by its unusualness in clinical form which was diagnosed during the postpartum period. The patient came to the hospital at 22 days postpartum. Sub-acute puerperal uterine inversion grade II was diagnosed. Manual maneuvers were made aiming to reduce the inversion. The results were unsatisfactory. It was required total abdominal hysterectomy; we managed to keep both adnexae and the life of the patient. Treatment is usually surgical, especially if not diagnosed in the labor third stage(AU)

Non-puerperal Uterine Inversion Presented with Hypovolemic Shock

We report a non-puerperal uterine inversion with nulliparous women caused by huge pedunculated submucosal fibroid. Massive bleeding from protruding mass through vagina brought the heart to stop in 42-year-old nulliparous woman. She became cardiopulmonary resuscitation survivor in emergency room and then underwent laparotomy which ended in successful myomectomy rather than hysterectomy considering her demand for future fertility. Meticulous and adequate fluid therapy and transfusion was also administered to recover from hypovolemic status. Pathologic report confirmed benign submucosal fibroid with degeneration, necrosis and abscess formation. Thus, clinician should be aware of uterine inversion when encountered with huge protruding vaginal mass and consider uterus-preserving management as surgical option when the future fertility is concerned.

Spontaneous Restoration of Unrecognized Uterine Inversion / 대한주산의학회잡지

We report a case of unrecognized uterine inversion was restored spontaneously without surgical intervention. Initially, the case was diagnosed as uterine atony and not uterine inversion and was managed successfully with uterine artery embolization. However, a partial uterine inversion was detected on a subsequent scheduled pelvic examination. Fortunately, her uterus was completely restored without any surgical intervention on eighth week after delivery.

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.

Inversión uterina puerperal crónica / Chronic puerperal uterine inversion

La inversión uterina es una entidad clínica poco frecuente y grave, descrita como una emergencia obstétrica relacionada con las complicaciones del tercer estadio del parto que necesita tratamiento inmediato, habitualmente quirúrgico. Con este artículo se pretende demostrar a la comunidad científica algunos elementos relacionados con esta, pues es probable que por su baja incidencia, generaciones actuales de obstetras no alcancen asistir una paciente con esta complicación, además por la ausencia de reportes nacionales relacionados con esta entidad. Se presenta una paciente que acudió al hospital, a los 2 meses después del parto, se diagnosticó una inversión uterina puerperal crónica grado II, fue necesario realizar la histerectomía total como tratamiento definitivo, lograron conservarse ambos anejos. La forma de presentación atípica en el cuadro clínico de esta paciente y la posibilidad de mostrar una evidencia gráfica de su presentación clínica y tratamiento quirúrgico, motivaron la presentación de este trabajo.

Uterine inversion is a rare and severe clinical entity described related to obstetric emergency in labor third stage complications, which needs immediate treatment, usually surgery. This article aims to show the scientific community some elements related to this, since it is likely that due to its low incidence, current generations of obstetricians do not assist patients with this complication, apart from the absence of national reports related to this entity. A patient came to the hospital 2 months after delivery, A chronic puerperal uterine inversion grade II was diagnosed. Total hysterectomy was necessary to perform as definitive treatment, achieving to retain both ovaries. The atypical presentation in this patient clinical condition and the ability to display graphic evidence of its clinical presentation and surgical treatment led to the presentation of this paper.

Non-puerperal uterine inversion: A case report / Philippine Journal of Obstetrics and Gynecology

Uterine inversion is a condition in which the uterus turns inside out with the fundus prolapsing to or through the cervix. Uterine inversion is classified into puerperal or nonpuerperal. Non-puerperal uterine inversion is a rare entity with no accurate estimate regarding its incidence available to date. A case of 25 year-old primipara with a one year history of abnormal uterine bleeding is presented. Her only pregnancy was 5 years prior to admission. She delivered a term baby girl of unrecalled birth weight vaginally, with no reported intrapartal or postpartum complications. Internal examination revealed a palpable mass within the middle third of the vagina measuring 4.0cm x 4.0cm x 4.0cm, doughy, with a smooth, spongy surface, seemingly prolapsed out of a smooth dilated cervix. The uterine corpus was not appreciated on bimanual examination. The patient was diagnosed to have uterine inversion and underwent conservative surgical reduction of the uterus initially with a vaginal approach using the Kustner technique which was later converted to an abdominal repair via the Haultain procedure. Non puerperal uterine inversion can be diagnosed and successfully managed in a lowresource environment, but may require the utilization of elements from several standard techniques before reduction is accomplished.

Uterine inversion: An entity or a rarity? / Philippine Journal of Obstetrics and Gynecology

The correct diagnosis and management of patients with uterine inversion will always remain as a challenge to any obstetrician. Two cases of puerperal uterine inversion managed differently are presented. In the first patient, there was delay in the diagnosis of uterine inversion and patient had to undergo hysterectomy. In contrast, there was early recognition of uterine inversion in the second patient prompting immediate manual repositioning.

Inversión uterina secundaria a legrado por aspiración de embarazo molar en una paciente adolescente / Uterine inversion secondary to suction curettage of molar pregnancy in an adolescent patient

La inversión uterina puerperal es una condición médica rara que ocurre con una frecuencia de 1 en 2,000 embarazos, sin embargo la inversión uterina no puerperal es aún más rara y se encuentra frecuentemente en pacientes mayores de 45 años y asociada a tumores. Se presenta el caso de una paciente de 15 años, primigesta, a quien se le realizó un legrado por aspiración endouterina por un embarazo molar y durante el procedimiento presentó inversión uterina. La paciente formo un anillo de constricción, por lo que la inversión fue resuelta con la técnica de Hualtain...

Inversion uterine: une cause inhabituelle d'hemorragie de la delivrance

L'inversion uterine puerperale est une complication obstetricale rare mais grave. Une mauvaise prise en charge de la troisieme phase du travail semble favoriser sa survenue. Nous en rapportons un cas observe chez une primipare de 19 ans ayant accouche a domicile avec delivrance hemorragique. Une reduction chirurgicale par voie basse etait pratiquee. Les particularites diagnostiques et les principes de la prise en charge sont discutes a la lumiere d'une revue de la litterature

Uterine Inversion : a Case Report

The puerperal uterine inversion is a rare and severe complication occurring in the third stage of labour. The mechanisms are not completely known. However; extrinsic factors such as oxytocic arrests after a prolonged labour; umbilical cord traction or abdominal expression are pointed. Other intrinsic factors such as primiparity; uterine hypotonia; various placental localizations; fundic myoma or short umbilical cord were also reported. The diagnosis of the uterine inversion is mainly supported by clinical symptoms. It is based on three elements: haemorrhage; shock and a strong pelvic pain. The immediate treatment of the uterine inversion is required. It is based on a medical reanimation associated with firstly a manual reduction then surgical treatment using various techniques. We report an observation of a 25 years old grand multiparous patient with a subacute uterine inversion after delivery at home

Prolapsed uterine sarcoma causing non-puerperal uterine inversion in a post menopausal woman.

A rare case of non-puerperal uterine inversion caused by a large fundal sarcoma in a 57 year old menopausal woman who presented with profuse vaginal bleeding is reported. After vaginal excision of the fundal myoma, reduction of the uterine inversion combined approach both abdominal as well as vaginal successfully was then followed by total abdominal hysterectomy and bilateral salphingoopherectomy.

Risk factors for primary postpartum hemorrhage

To describe the associated risk factor for primary Postpartum Hemorrhage [PPH] and its severity with increasing parity and duration of labour. It was a descriptive study. Place and duration of study: The Department of Obstetrics and Gynecology [Unit II] of Bahawal Victoria Hospital, Bahawalpur from January 2004 to December 2004. Patient and method: Fifty patients with primary postpartum hemorrhage were included in this study. Data was collected from the patients through a structured proforma. The variable studied were parity, duration of labour and risk factors for primary PPH. The results were statistically analyzed, chi-square test was applied to find out the significance of parity and duration of labour and their relationship with severity of PPH. Simple percentages were used to find associated risk factor for primary PPH. The frequency of primary PPH in primary para was 24% [12 patients] and in multi para was 76%[38 patients]. Severity of PPH increased with increasing parity [P<.05]. After merging the variable of parity severity of PPH increased in patients with prolonged labour in normally delivered patients [P<.05]. As for as risk factors are concerned 60% had uterine atony while 16% got cervical tear and the same number had retained placenta, 8% had preneal tear, Uterine inversion was seen in 6%, 4% presented with polyhydrominos, same with placenta previa type-1. 4% had vaginal laceration, 2% had DIC and 2% had abruptio placenta. The result of the study revealed a number of associated risk factors for primary PPH and proved the relationship of its severity with increasing parity and duration of labour. Duration of labour had a significant relationship with PPH even in Primipara

A case of uterine inversion resulted from prolapse of huge pedunculated uterine submucosal leiomyoma / 대한산부인과학회지

Uterine leiomyomas are the most common uterine tumors. They are estimated to be present in approximately 20% of all women of reproductive age. They may be present in subserosal, intramural, or submucosal in location within the uterus, or located in the cervix, in the broad ligaments, or on a pedicle. Many studies report that the malignant potential of a preexisting uterine leiomyoma is extremely rare, occuring in less than 0.5%. Uterine leiomyomas may cause a range of syptoms, for example, severe anemia from abnormal uterine bleeding, dysmenorrhea, constipation from rectosigmoid compression, dysuria, frequency, residual sensation due to bladder compression. Patients with those symptoms or "cancer phobia" should be treated. Rare but severe symptoms associated with uterine leiomyomas are rectosigmoid compression, with intestinal obstruction, thrombophlebitis of lower extremities from venous stasis, polycythemia, ascites, severe pain from torsion and infection of prolapsed pedunculated submucosal myoma and uterine inversion from prolase of pedunculated submucosal leiomyoma. Now we report a rare case of uterine inversion resulted from prolapse of huge pedunculated uterine submucosal leiomyoma, which caused hypovolemic shock due to massive uterine bleeding.

Chronic non puerperal inversion of uterus

Inversion of the uterus is a rare clinical problem. It occurs either as an obstetric emergency or as a gynecological complication where it is a diagnostic challenge. A rare case of non- puerperal inversion, caused by fundal leiomyoma, was encountered in a-59- year old woman resulting in severe vaginal bleeding. It was thought initially to be a large pedunculated fibroid polyp, but it was discovered to be associated with inversion during surgery. She was treated with total hysterectomy using an abdominal and vaginal approach

Inversión uterina puerperal crónica: presentación de un caso y revisión de la literatura / Chronic uterine inversion: a case report and review of the literature

Se presenta un caso de diagnóstico tardío de inversión uterina poco frecuente en la literatura médica. El cuadro clínico de la paciente incluía sangrado genital moderado persistente y dispareunia de 14 meses de evolución. La técnica de reposicionamiento uterino se realizó por vía vaginal con revisión posterior por vía laparoscópica y evolución satisfactoria. Se hace una revisión de la literatura.