Summary about Disease
Uterine inversion is a rare but serious obstetric emergency where the uterus turns inside out, often following childbirth. It can be classified based on the degree of inversion (incomplete, complete, prolapsed, or total) and the timing (acute, subacute, or chronic). It is a potentially life-threatening condition due to the risk of severe hemorrhage and shock. Prompt recognition and management are crucial.
Symptoms
Sudden, severe abdominal pain
Heavy vaginal bleeding (hemorrhage)
Feeling of fullness or pressure in the vagina
Visible mass protruding from the vagina (in complete or prolapsed inversions)
Signs of shock (rapid heart rate, low blood pressure, dizziness, lightheadedness, loss of consciousness)
Causes
Uterine inversion is primarily caused by:
Excessive traction on the umbilical cord before placental separation
Fundal pressure (pushing on the top of the uterus) when the uterus is relaxed or not contracted
Short umbilical cord
Uterine atony (failure of the uterus to contract adequately after childbirth)
Abnormally adherent placenta (placenta accreta, increta, or percreta)
Connective tissue disorders may be a predisposing factor
Medicine Used
The medications used in managing uterine inversion focus on uterine relaxation, pain management, and counteracting shock.
Uterine relaxants:
Terbutaline: To relax the uterus and allow for manual replacement.
Magnesium sulfate: Also used for uterine relaxation.
Nitroglycerin: Can be used intravenously.
Halogenated Anesthetics during manual replacement.
Oxytocic Agents (after replacement):
Oxytocin (Pitocin): To stimulate uterine contractions and prevent re-inversion once the uterus is repositioned.
Methylergonovine (Methergine): Another uterotonic agent, contraindicated before manual replacement.
Misoprostol (Cytotec): Can be used rectally to promote uterine contraction.
Pain Management:
Opioids: For severe pain.
Volume Resuscitation:
Intravenous fluids (crystalloids or colloids): To treat hypovolemic shock caused by hemorrhage.
Blood Transfusions: To replace lost blood.
Antibiotics:
Broad-spectrum antibiotics: to prevent infection, especially if manual replacement was difficult or traumatic.
Is Communicable
No, uterine inversion is not a communicable disease. It is a mechanical complication of childbirth.
Precautions
While uterine inversion is often unpredictable, the following precautions can help minimize the risk:
Avoid excessive traction on the umbilical cord before placental separation.
Avoid fundal pressure on a relaxed uterus.
Careful management of the third stage of labor (delivery of the placenta).
Early recognition and treatment of uterine atony.
Consider risk factors such as previous uterine inversion, placenta accreta, and connective tissue disorders.
Ensure adequate anesthesia if manual replacement is required.
How long does an outbreak last?
Uterine inversion is not an outbreak. It is an acute event that occurs during or immediately after childbirth. The duration depends on how quickly it is recognized and treated. If managed promptly, the acute phase lasts only a few hours. Chronic uterine inversion is rare and can persist for weeks if not diagnosed and treated.
How is it diagnosed?
Diagnosis is primarily clinical, based on:
Visual inspection: Identification of a mass protruding from or within the vagina.
Palpation: Absence of the uterine fundus in the abdomen.
History: Recent childbirth, possibly with traction on the umbilical cord or fundal pressure.
Ultrasound: Can be used in unclear cases to visualize the inverted uterus.
Timeline of Symptoms
Immediate postpartum: Sudden onset of severe abdominal pain and vaginal bleeding.
Within minutes: Development of signs of shock (rapid heart rate, low blood pressure).
Minutes to hours: Visible mass protruding from the vagina.
If untreated: Continued hemorrhage, worsening shock, and potential for death.
Delayed/Chronic Inversion (rare): More insidious onset of pelvic pain, bleeding, and vaginal discharge, potentially weeks after delivery.
Important Considerations
Prompt Recognition is Key: Uterine inversion is a life-threatening emergency requiring immediate action.
Multidisciplinary Approach: Requires the coordinated efforts of obstetricians, anesthesiologists, and nurses.
Management Priorities: Resuscitation (IV fluids, blood transfusion), uterine relaxation, manual replacement of the uterus, and prevention of re-inversion.
Surgical intervention: May be necessary if manual replacement fails. Hysterectomy may be required as a last resort to control hemorrhage.
Psychological Support: The event can be traumatic for the patient and family, requiring psychological support and counseling.