Uterine Inversion: Etiology, Prevention, Diagnosis, and Management

Introduction

Uterine inversion is a rare but potentially life-threatening obstetric emergency characterized by the turning inside-out of the uterus. Understanding its etiology, risk factors, and management is crucial for healthcare professionals.

Etiology and Classification

Classification

Acute Uterine Inversion – Occurring within 24 hours post-delivery.
Subacute Uterine Inversion – Diagnosed after 24 hours but within a few weeks.
Chronic Uterine Inversion – Persisting beyond four weeks.

Risk Factors

Fundal placental implantation
Excessive traction on the umbilical cord
Uterine atony
Short umbilical cord
Rapid labor

Pathophysiology

The inversion process begins with excessive pulling on the placenta or weakened uterine walls, leading to a downward displacement of the uterus. Severe hemorrhage and shock often accompany the condition.

Prevention and Diagnosis

Prevention

Avoid excessive umbilical cord traction.
Administer uterotonics appropriately.
Perform controlled cord traction under medical supervision.

Diagnosis

Clinical examination is the primary method for detecting uterine inversion. Symptoms include severe postpartum hemorrhage, shock, and a palpable fundal defect on vaginal examination.

Management

Non-Surgical Approach

Immediate fluid resuscitation
Manual repositioning of the uterus
Administration of uterotonics post-repositioning

Surgical Approach

When manual repositioning fails, surgical interventions such as the Huntington or Haultain procedure may be required.

Conclusion

Timely diagnosis and management of uterine inversion are crucial for preventing complications. A multidisciplinary approach involving obstetricians, anesthesiologists, and nurses is essential for optimal patient outcomes.