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Postpartum hemorrhage
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Wade D. Schwendemann, William J. Watson
Rare causes of postpartum hemorrhage should not be discounted. During the pelvic examination following delivery, uterine inversion can be diagnosed. This condition often presents as a beefy-red mass at the introitus. Failure to visualize the cervix around this mass should arouse the clinical suspicion for this condition. The clinician may mistake this for a prolapsed leiomyoma. Once inversion is recognized, attempts at manual replacement should be made first (23,24). Should this fail to alleviate the problem, IV nitroglycerine can be administered in hopes of relaxing the uterus. If attempts at medical therapy also fail, a laparotomy should be performed; the uterus can then be reverted by progressive traction on the round ligaments or, if this fails, by incising the uterine contraction ring posteriorly. The vertical incision should then be repaired in layers, similar to the repair of any other vertical uterine incision (25).
Acute Uterine Inversion
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Kapila Gunawardana
Mismanagement of the third stage of labour, mainly inappropriate traction on the umbilical cord while the placenta is attached to the uterus is the most common cause of acute uterine inversion (Figure 21.2). Pressure on the uterine fundus before placental separation can also lead to acute uterine inversion.
Obstetrics: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Signs and symptoms of uterine inversion include severe lower abdominal pain, bleeding, shock due to vagal stimulation, a non-palpable uterus or a dimpled fundus, and a mass in the vagina or outside the introitus (5).
Maternal outcomes following massive obstetric haemorrhage in an inner-city maternity unit
Published in Journal of Obstetrics and Gynaecology, 2019
Michael G. Fadel, Sayantana Das, Alexander Nesbitt, Kathryn Killicoat, Irene Gafson, Wasim Lodhi, Wai Yoong
When divided into groups based on volume of blood loss (2000–3000 vs. >3000 mL), there was no significant difference in any maternal characteristic (Table 2). The mean estimated blood loss in Group A was 2191 mL and in Group B it was 4200 mL. The main causes of PPH in Group A and Group B were uterine atony (49 vs. 52%), followed by trauma (25 vs. 32%), placental abruption (12 vs. 22%), placental praevia (8 vs. 22%) and placental accreta (4 vs. 12%). Other causes reported included amniotic fluid embolism, clotting disorder and uterine inversion. There was a significant difference in a placenta praevia being the cause of a massive PPH (p = .010). There was also a reported significant difference in the length of a hospital stay (Group A = 4.57 d, Group B = 5.86 d, p = .0167) (Table 3). No maternal deaths were reported. The neonatal outcomes included a 12% neonatal unit admission rate in Group A and 16% in Group B, and a mean APGAR at one minute of 7.63 in Group A and 8.00 in Group B.
A case report of an aggressive rhabdomyosarcoma associated with non-puerperal uterine inversion
Published in Journal of Obstetrics and Gynaecology, 2020
Afshan Ambreen, FarhatulAin Ahmed, Sobia Zafar, Sara Khan
The clinical diagnosis of uterine inversion is made on the following observations; finding a mass coming through the cervix, without definitive margins of the cervix and absence of uterine fundus on bimanual examination. Distorted anatomy makes diagnosis difficult in some cases and the use of ultrasound and MRI or CT is necessary. Lewin et al. reported T2-weighted MRI scans as being an important tool for diagnosis. A U-shaped uterine cavity and thickened inverted uterine fundus on a sagittal image and a ‘bull eye configuration’ on an axial image are signs suggesting uterine inversion (Lewin and Bryan 1989).
Chronic non-puerperal uterine inversion in an asymptomatic woman
Published in Journal of Obstetrics and Gynaecology, 2018
Tânia Lima, Rita Sousa, Angelina Pinheiro, Amélia Almeida
Uterine inversion is an uncommon condition and normally occurs after a vaginal delivery. Non-puerperal uterine inversion is so rare that its incidence is difficult to estimate. A review of literature from 1940 to 2009 by Costa et al. (2010) found a total of 142 cases: 59.1% associated with leiomyomas, 25.3% with sarcomas and 9.2% with endometrial carcinoma.