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Acute puerperal uterine inversion.

Munawar Hussain1, Tahira Jabeen, Nagina Liaquat

  • 1Department of Obstetrics and Gynaecology, JPMC, Karachi.

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
|July 2, 2004
PubMed
Summary

Acute puerperal uterine inversion occurred in 1 in 1584 deliveries, often due to mismanagement of the third stage of labor. Prompt manual replacement is effective, but education is crucial to prevent this life-threatening obstetric emergency.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal Health
  • Reproductive Medicine

Background:

  • Acute puerperal uterine inversion is a rare but serious obstetric emergency.
  • It can lead to significant maternal morbidity and mortality if not managed promptly.

Purpose of the Study:

  • To determine the frequency, causes, clinical presentations, management, and maternal mortality associated with acute puerperal inversion of the uterus.

Main Methods:

  • A cross-sectional analytical study was conducted over eight years (1995-2002) at Jinnah Postgraduate Medical Centre, Karachi.
  • Included patients with acute uterine inversion; excluded chronic cases.
  • Confirmed and classified inversion using abdominal and vaginal examinations.

Main Results:

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  • The frequency of acute uterine inversion was 1 in 1584 deliveries (36 cases out of 57,036 deliveries).
  • Mismanagement of the third stage of labor was the cause in 75% of cases.
  • Most patients presented with shock (hypovolemic or neurogenic); 97.5% were successfully treated with manual replacement, with three maternal deaths.

Conclusions:

  • Mismanagement of the third stage of labor is a primary cause of acute puerperal uterine inversion.
  • Prompt diagnosis and manual replacement are effective management strategies.
  • Education and training for maternity care providers are essential to prevent this potentially life-threatening condition.