Complete acute uterine inversion
Lawrence Mbuagbaw, Patrick Mbah Okwen
The Pan African Medical Journal. 2013;16:33. doi:10.11604/pamj.2013.16.33.1956

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Complete acute uterine inversion

Cite this: The Pan African Medical Journal. 2013;16:33. doi:10.11604/pamj.2013.16.33.1956

Received: 11/08/2012 - Accepted: 02/01/2013 - Published: 30/09/2013

Key words: Acute uterine inversion, post-partum, placenta, childbirth

© Lawrence Mbuagbaw et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/16/33/full

Corresponding author: Lawrence Mbuagbaw, Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Avenue Henri Dunant, Messa, PO Box 87, Yaoundé, Cameroon (mbuagbawl@yahoo.com)


Complete acute uterine inversion

 

Lawrence Mbuagbaw1,&, Patrick Mbah Okwen1

 

1Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Avenue Henri Dunant, Messa, PO Box 87, Yaoundé, Cameroon

 

 

&Corresponding author
Lawrence Mbuagbaw, Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Avenue Henri Dunant, Messa, PO Box 87, Yaoundé, Cameroon

 

 

Image in medicine

Acute uterine inversion is a rare and life-threatening post-partum complication which often occurs when the placenta fails to detach from the uterus after childbirth. The uterine fundus falls into the endometrial cavity and may descend to the cervix (incomplete) or beyond the cervix (complete). Death may occur in 15% of the affected mothers due to pain, blood loss and shock. The shock is often described as being "out of proportion" to the bleeding. Uterine inversion is associated with primiparity, the use of oxytocin, macrosomia and fundal insertion of the placenta. Premature traction on the umbilical cord and fundal pressure before placental separation are the usual direct causes. Care for acute uterine inversion involves pain management, resuscitation and replacement of the inverted uterus before oedema sets in. Surgery may be required in severe cases. We present here the case of a 37 year old woman, gravida 4 para 4, who was rushed into our services. This is a picture of complete uterine prolapse with a totally inverted endometrium. The entire uterus can be seen protruding through the vulva. The placenta is no longer attached, but its point of insertion can be seen (dark red central portion). She was in pain, but was not bleeding at the time of admission. There were no signs of shock. Management involved parenteral antibiotics and fluids; cleaning and debridement of exposed endometrium; and replacement of the uterus in the abdominal cavity using the Johnson manoeuvre.

Figure 1: Completely inverted uterus

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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