A case of third degree hemorrhagic shock due to total subacute uterine inversion after delivery

Abstract

Uterine inversion is a rare, but life-threatening obstetric emergency. We describe a case of total subacute uterine inversion in settings with limited resources. A multiparous (P4) 29-year-old woman with history of delivery assisted by a traditional birth attendant who used the fundal pressure technique 4 days before admission was referred due to postpartum hemorrhage. She had low blood pressure, tachycardia, and lethargic. A protruding mass from the vaginal introitus with active bleeding was visible. She diagnosed with third degree hemorrhagic shock due to total subacute uterine inversion. Resuscitation was initiated immediately and manual uterine repositioning was performed under general anesthesia. After two failed attempts, a laparotomy was performed to apply traction to the round ligaments and an incision on the cervical ring by using Allis clamps. The inversion was resolved. Next, subtotal hysterectomy was done to stop bleeding and infection.

Uterine inversion in retained placenta, that’s why a good management of third stage of labor matters: A case report

“…Based on timing, uterine inversion can be classified as acute (within 24 h after delivery), subacute (more than 24 h but less than 4 weeks after delivery), or chronic (more than 4 weeks after delivery). 2 The etiology of the uterine inversion remains elusive and unexplained, generally associated with excessive cord traction in the third stage of labor. 1 , 3…”

“…The incidence varies considerably and can range from 1 case in 2000 to 1 case in every 50,000 birth. 1 , 2 This postpartum complication holds academic significance owing to its rare occurrence and severity. However, its low incidence makes obstetricians experience regarding this condition is scarce.…”

“…3 Some studies have also hypothesized antepartum use of magnesium sulfate and oxytocin as a risk factor for uterine inversion; however, they are yet to be proven scientifically. 1 – 4 Though a physical examination of uterine inversion typically reveals a mass-like uterine fundus in the vagina, the diagnosis of uterine inversion is often difficult due to massive postpartum hemorrhage. 5 There are several therapeutic strategies describe in the literature including drugs, manual maneuvers called Johnson’s Maneuver and surgical intervention.…”