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Acute puerperal inversion of the uterus--treatment by a new abdominal uterus preserving approach
1IVF-Unit, Women's General Hospital, Lederergasse 47, A-4020 Linz, Austria. gernot.tews@li.lkh.ooe.gv.at
Objective:
Inversion of the uterus is still a rare (1, 2) but serious and life-threatening obstetric complication. It is said to be complete when the fundus uteri protrudes through the cervix and into the vagina. Within minutes a state of shock is reached due to pulling forces on the peritoneum as well as blood loss.
Methods:
The vagina was entered by a longitudinal incision (3 m) below the contraction ring. Through this opening it was possible to advance two fingers (second and third finger of the left hand) into the vagina above the invaginated corpus uteri. The invaginated cavum uteri was loaded on these two fingers and, exerting counterpressure with the right hand, the inside was turned out.
Conclusion:
The present operative method guarantees easy reposition of the uterus in cases of failed vaginal manual repositioning. Furthermore, the cavum uteri remains intact and hysterectomy can be avoided.
