Uterine inversion

A medical condition involving the uterus

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Historical depiction of uterine inversion.

Uterine inversion is a rare medical condition where the uterus turns inside out, usually following childbirth. This condition can lead to severe hemorrhage and shock, and requires immediate medical attention.

Classification

Uterine inversion is classified based on the degree of inversion:

• Incomplete inversion: The fundus of the uterus is inverted but does not protrude through the cervix.
• Complete inversion: The fundus protrudes through the cervix into the vagina.
• Prolapsed inversion: The fundus extends outside the vaginal introitus.
• Total inversion: The uterus and sometimes the vagina are inverted.

Causes

The exact cause of uterine inversion is not always clear, but several factors can contribute to its occurrence:

• Excessive traction on the umbilical cord during the third stage of labor.
• Abnormal adherence of the placenta (placenta accreta).
• Weakness of the uterine wall.
• Rapid delivery.

Symptoms

Symptoms of uterine inversion can include:

• Severe pelvic pain.
• Profuse vaginal bleeding.
• A visible mass at the vaginal opening.
• Hypotension and shock.

Diagnosis

Diagnosis is typically made through physical examination. The condition is often apparent due to the presence of a mass in the vagina or outside the vaginal opening. Ultrasound may be used to confirm the diagnosis.

Treatment

Immediate treatment is crucial to prevent severe complications. Treatment options include:

• Manual replacement: The uterus is manually repositioned by a healthcare provider.
• Surgical intervention: If manual replacement is unsuccessful, surgical methods such as the Haultain procedure may be necessary.
• Medications: Oxytocin and other uterotonics may be administered to help contract the uterus after repositioning.

Prognosis

With prompt treatment, the prognosis for uterine inversion is generally good. However, delayed treatment can lead to significant morbidity and mortality due to hemorrhage and shock.

Prevention

Preventive measures include careful management of the third stage of labor, avoiding excessive traction on the umbilical cord, and ensuring proper uterine contraction after delivery.

Related pages

• Postpartum hemorrhage
• Placenta accreta
• Obstetric emergencies

Images

Early 20th-century medical illustration.

Gynecological textbook illustration.

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