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.

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)

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.

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

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

Puerperal uterine inversion, a case report

Acute puerperal uterine inversion is a rare but life threatening complication in which the uterine fundus collapses within the endometrial cavity. The rate of uterine inversion is estimated from one in 2000 to one in several hundred thousand labors. Although the cause of uterine inversion is unclear, several predisposing factors have been described. Maternal mortality is extremely high unless the condition is immediately recognized and corrected. The patient was a pregnant woman [G [2] P [1], 27 years old, admitted in Yasuj Imam Sadjad Hospital due to onset of labor pains. The patient had history of cesarean section in first pregnancy and the indication of cesarean was unclear. She wanted to have vaginal delivery. Delivery was taken normally. Placenta exited the vagina together with dark-red mass attached to it. Placenta was detached simply from the mass. The mass did not have massive bleeding. With diagnosis of uterine inversion manual correction of inversion was begun. The inversion was converted from complete to incomplete inversion. The correction was not completely successful. The patient's condition was poor and went to shock. Because of these reasons the patient underwent manual reinsertion of the uterus under general anesthesia and then was prepared for surgical correction. Although the uterine inversion is not very common, it will result in severe hemorrhage and shock, if left unrecognized, and leads to maternal death

Non-puerperal uterine inversion -a case report

Inversion of the uterus is a rare clinical problem. It is encountered as an obstetric emergency and a diagnostic challenge in gynecology. Non-puerperal inversion usually results from a tumor implanted on fundus of the uterus. Treatment depends on the associated pathology and the stage. A rare case of non-puerperal uterine inversion caused by a large fundal leiomyoma was reported in Bahounar Hospital, Kerman, in a 38 years old woman resulting in severe lower abdominal pain and profuse vaginal bleeding. After incomplete myomectomy, reduce the inversion vaginally was successful and abdominal hysterectomy was performed