Acute Uterine Inversion with 2nd Degree Perineal Tear
Journal Title: Indian Journal of Obstetrics and Gynecology - Year 2018, Vol 6, Issue 5
Abstract
Introduction: The acute peurperal uterine inversion is a rare obstetric emergency and a severe complication occurring in the third stage of labour. The diagnosis of uterine inversion is made on the basis of clinical symptoms which include haemorrhage, shock and a strong pelvic pain. Case Report: A 24 year old, para 2 , living 2 , delivered vaginally at a primary health care centre three hours prior to admission was referred in view of mass per vagina and shock. On per abdominal examination there was suprapubic tenderness and the uterine fundus could not be palpated. The local examination revealed a 2nd degree perineal tear with profuse vaginal bleeding, a uterine mass was visualised in the vagina and the diagnosis of acute uterine inversion was made. Under general anaesthesia, manual correction was attempted but failed. A laprotomy was done; another attempt to correct inversion by applying traction on the round ligaments was made but was unsuccessful. An incision was taken on the posterior surface of the ring formed by the cervix and via vaginal manipulation the fundus was pulled up and uterine reposition was achieved. As persistent uterine atonicity was noted B –Lynch & square stitches were put on the uterine fundus and bilateral uterine artery ligation was done. The 2nd degree perineal tear was sutured in layers. Three units of blood were transfused intra operatively and postoperative use of uterotonic agents, antibiotics, analgesics lead to an uneventful recovery of the patient. Conclusion: Acute uterine inversion is accompanied by high risk of postpartum haemorrhage and the best prognosis occurs where the diagnosis and manoeuvres are made at an early stage.
Authors and Affiliations
V. R. Gobbur .
Keywords
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- EP ID EP550158
- DOI 10.21088/ijog.2321.1636.6518.18
- Views 55
- Downloads 0
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