Acute puerperal inversion of the uterus

ABSTRACT

To report on rare cases and discuss their various clinical presentations and different modalities of treatment. King Abdulaziz University Hospital, and Maternity and Children's Hospital, Jeddah. Patients delivered during the period 1980-1990. Retrospective analysis of patients' data and treatment modalities as collected from their files. Eight cases of acute puerperal inversion of the uterus were encountered among 133 644 deliveries giving an approximate prevalence of one in 16 505. Common presenting features were haemorrhage, shock and a mass protruding through the vulva. The difficulty in diagnosis is signified by the fact that two cases were of the incomplete type and in one case the mass protruding through the vulva was mistaken for the placenta. Six of the cases were managed by manual replacement under general anaesthesia; immediate replacement was successful in one case and one was managed by hydrostatic replacement. Acute puerperal inversion of the uterus is a rare obstetrical emergency. A high index of suspicion is needed in cases of unexplained haemorrhage or postpartum collapse. Immediate recognition and replacement are the cornerstone of management