Subacute uterine inversion: description of a novel replacement technique using the obstetric ventouse

Abstract

Please cite this paper as: Antonelli E, Irion O, Tolck P, Morales M. Subacute uterine inversion: description of a novel replacement technique using the obstetric ventouse. BJOG 2006; 113:846-847. Case reportA 27-year-old black African primigravida with an uneventful antenatal course was admitted in active labour at term. Six hours following admission, the cervix was fully dilated. The second stage of labour lasted 45 minutes and a 3200-g male infant was born without apparent complications. Five units of oxytocin were given intravenously with delivery of the anterior shoulder, and the complete placenta delivered spontaneously 15 minutes later without any need for cord traction. The postpartum period was uneventful until day 4 when the woman complained of acute pelvic pain associated with the desire to pass urine. Increased vaginal bleeding was noted at the same time. Vaginal examination revealed complete uterine inversion. The woman was taken immediately to the operating theatre, where an initial attempt at manual replacement under epidural analgesia was unsuccessful because of a constricted cervix. Terbutaline was administrated intravenously but a further effort at replacement failed and it was decided that a surgical reduction should be undertaken. Laparotomy revealed a complete uterine inversion, with bladder and ovaries pulled down through the inverted uterus. A Silastic Ò cup (Silc-cup; Menox AB, Gothenburg, Sweden) was easily inserted into the inverted uterus ( Figure 1A), a vacuum was created and a gentle traction achieved reduction of the inversion ( Figure 1B). Digital examination demonstrated an empty uterine cavity and an intact cervix. Twenty units of oxytocin were then administrated intravenously by slow infusion over 12 hours and broad-spectrum antibiotics were prescribed. The woman was discharged well 4 days later.

Uterine inversion: a shocking aftermath of mismanaged third stage of labour

“…11 Since then, Antonelli et al have described a new technique of using a silastic cup at the time of laparotomy. 12 Use of an intrauterine Rusch balloon catheter (Modified hydrostatic method) has also been reported. 13 Although they were managed by a well-coordinated team approach with obstetrician and anesthetist yet there were some who could not be revived with best resuscitative measures by the time they reached here.…”

A unique case of recurrent uterine inversion requiring double reposition

“…The surgical methods include the incision of the constriction ring vaginally (Spinelli), upward traction on the round ligaments with the assistant applying upward pressure from the vagina (Huntington) and incising the constriction ring posteriorly at laparotomy (Haultain). The newer methods include laparoscopic reduction 2 , the use of obstetric ventouse at laparotomy 3 , and application of cephalad traction on the deepest visible part of the posterior uterus 4 .…”

Management of Uterine Inversion: An Obstetric Catastrophe

“…(Haultain's operation) . 21,22 • Anterior median hysterotomy may need to be performed which is called Dobbin's operation. 22 Then the uterine incision is repaired with closure of abdomen.…”

“…Therefore minimum length of hysterotomy incision after laparotomy can achieve correction of inversion. 20 Surgical correction of uterine inversion through the vaginal route can be achieved by the Spinelli method 22 which consists of anterior median colpohysterotomy through the vaginal access for removal of the cervical constriction. Finally, hysterectomy is indicated for a gangrenous or infected puerperal uterus after failed conservative treatment.…”

“…Synchronously an assistant may assist correction vaginally. 21,22 If traction fails, the constricting cervical ring is incised posteriorly about 5 to 6 cm which is least likely to injure the bladder or uterine vessels and digital dilatation, tenaculum and traction steps are repeated till reversal of inversion is achieved . (Haultain's operation) .…”