ACUTE INVERSION OF THE

UTERUS
M.THAMRIN TANJUNG

Acute Inversion of the Uterus

Definition:
The body of the uterus is partially or
completely turned inside out.
Incidence:
very rare about 1: 20.000 deliveries.

Aetiology
(I) Spontaneous inversion caused by:
1- Precipitate labour.
2- Traction on a short cord by the foetus.
3- Straining or coughing while the uterus is lax,
particularly if the cervix is torn or gaped.
4- Submucous fundal myoma.
(II) Iatrogenic inversion caused by:
1. pressure on the fundus or,
2. traction on the cord while the uterus is lax.

Degrees
First degree : The fundus is just
depressed.
Second degree: The inverted fundus
protrudes through the cervix.
Third degree: The whole uterus, including
the cervix, is inverted and may drag the
vagina and appear outside the vulva.
N.B.
- Incomplete inversion : First or second degree.
- Complete inversion: Third degree.

Clinical Picture
(A) Symptoms:
1. Pain : in the lower abdomen.
2. Sensation of vaginal fullness: with a desire to
bear
down after delivery of the placenta.
3. Vaginal bleeding: unless the placenta is not
separated.
4. Subacute inversion: There is minimal
symptoms and the condition is discovered later
when the patient develops blood stained
offensive vaginal discharge due to infection.

Clinical Picture
(B) Signs:
(1) General examination:
Shock is out of proportion to the amount of blood loss as it
is more neurogenic due to traction on the peritoneum and
pressure on tubes, ovaries and may be the intestine.
(2) Abdominal examination:
- Cupping of the fundus -------- in the 1st and 2nd degrees.
- Absence of the uterus --------- in the 3rd degree.
(3) Vaginal examination:
In the 2nd and 3rd degrees the inverted uterus appears as
a soft purple mass in the vagina or at the vulva.

Management
(1) Anti - shock measures.
(2) Manual reduction:
- After resuscitation , the inverted uterus is reduced
manually under anaesthesia, but do not delay reduction
as
the uterus will be oedematous and difficult to be
replaced.
- The part inverted last is replaced first so fundus is
replaced finally.
- If the placenta is still attached it is removed.
- Massage the uterus and give ergometrine, IV oxytocin
drip and antibiotics.

 (3) Hydrostatic reduction:

Replacement is possible by fluid pressure with warm
saline delivered into the
vagina through a wide bore tube from a container
held at a height of about 60
cm. The vaginal introitus is closed by holding the
labia major together.
(4) Surgical reduction:
- It is indicated in subacute and chronic inversions.
- The cervix is incised posteriorly or anteriorly either
vaginally or abdominally to reposite the uterus.