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Complete uterine inversion during caesarean section: A case report.

Vavilis D, Tsolakidis D, Athanatos D, Goutzioulis A, Bontis JN - Cases J (2008)

Bottom Line: Inversion of the uterus through the uterine lower segment incision during a caesarean section is an extremely rare obstetric incident.It consists, though, an emergency complication that is potentially life-threatening, especially in cases of prolonged inversion, because haemodynamic instability and shock may occur.Prompt diagnosis and immediate uterine reversion are the key actions in the management of this serious complication.

View Article: PubMed Central - HTML - PubMed

Affiliation: First Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, 'Papageorgiou' Hospital, Thessaloniki, Greece. vavilis@auth.gr.

ABSTRACT
Inversion of the uterus through the uterine lower segment incision during a caesarean section is an extremely rare obstetric incident. It consists, though, an emergency complication that is potentially life-threatening, especially in cases of prolonged inversion, because haemodynamic instability and shock may occur. Prompt diagnosis and immediate uterine reversion are the key actions in the management of this serious complication.

No MeSH data available.


Related in: MedlinePlus

Complete uterine inversion with fundally implanted placenta (Top: fundus of the uterus, bottom: cervical contraction ring).
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Figure 1: Complete uterine inversion with fundally implanted placenta (Top: fundus of the uterus, bottom: cervical contraction ring).

Mentions: Delivery of the fetus was uneventful. After the baby was born, an intravenous bolus of 10 i.u of oxytocin was administered. Uterine contraction was noted and gentle cord traction was applied in order to remove the placenta. With slight cord traction, complete inversion of the uterus, through the uterine incision occurred with the placenta remaining firmly attached to the uterine fundus (Fig. 1). The inverted uterus was exteriorized at once and the placenta was manually removed. Several attempts for uterine reversion were done unsuccessfully for less than five minutes. Eventually, sevoflurane anesthesia was deepened from 1% to 5% and reversion of the uterus was finally achieved by gradually rolling the lowermost part of the posterior edge over the uterine fundus, thereby reverting that part that inverted last. The uterus was repositioned intraabdominally and an infusion of 20 i.u oxytocin plus 0.2 mg methylergometrine in 1000 ml Ringer's Lactated set maintained the uterine contractions. Sevoflurane progressively was reduced to the initial concentration. Uterine closure was followed by closure of the abdominal cavity. No significant changes in the haemodynamic status of the patient were noted during the operation. Blood loss was estimated at 1500 ml and two units of whole blood were transfused. After the end of cesarean section, 0.8 mg of misoprostol was given per rectum. The postoperative period was uneventful and the patient was discharged from the hospital on the 4th postoperative day.


Complete uterine inversion during caesarean section: A case report.

Vavilis D, Tsolakidis D, Athanatos D, Goutzioulis A, Bontis JN - Cases J (2008)

Complete uterine inversion with fundally implanted placenta (Top: fundus of the uterus, bottom: cervical contraction ring).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2533299&req=5

Figure 1: Complete uterine inversion with fundally implanted placenta (Top: fundus of the uterus, bottom: cervical contraction ring).
Mentions: Delivery of the fetus was uneventful. After the baby was born, an intravenous bolus of 10 i.u of oxytocin was administered. Uterine contraction was noted and gentle cord traction was applied in order to remove the placenta. With slight cord traction, complete inversion of the uterus, through the uterine incision occurred with the placenta remaining firmly attached to the uterine fundus (Fig. 1). The inverted uterus was exteriorized at once and the placenta was manually removed. Several attempts for uterine reversion were done unsuccessfully for less than five minutes. Eventually, sevoflurane anesthesia was deepened from 1% to 5% and reversion of the uterus was finally achieved by gradually rolling the lowermost part of the posterior edge over the uterine fundus, thereby reverting that part that inverted last. The uterus was repositioned intraabdominally and an infusion of 20 i.u oxytocin plus 0.2 mg methylergometrine in 1000 ml Ringer's Lactated set maintained the uterine contractions. Sevoflurane progressively was reduced to the initial concentration. Uterine closure was followed by closure of the abdominal cavity. No significant changes in the haemodynamic status of the patient were noted during the operation. Blood loss was estimated at 1500 ml and two units of whole blood were transfused. After the end of cesarean section, 0.8 mg of misoprostol was given per rectum. The postoperative period was uneventful and the patient was discharged from the hospital on the 4th postoperative day.

Bottom Line: Inversion of the uterus through the uterine lower segment incision during a caesarean section is an extremely rare obstetric incident.It consists, though, an emergency complication that is potentially life-threatening, especially in cases of prolonged inversion, because haemodynamic instability and shock may occur.Prompt diagnosis and immediate uterine reversion are the key actions in the management of this serious complication.

View Article: PubMed Central - HTML - PubMed

Affiliation: First Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, 'Papageorgiou' Hospital, Thessaloniki, Greece. vavilis@auth.gr.

ABSTRACT
Inversion of the uterus through the uterine lower segment incision during a caesarean section is an extremely rare obstetric incident. It consists, though, an emergency complication that is potentially life-threatening, especially in cases of prolonged inversion, because haemodynamic instability and shock may occur. Prompt diagnosis and immediate uterine reversion are the key actions in the management of this serious complication.

No MeSH data available.


Related in: MedlinePlus