Jump to content

Uterine inversion: Difference between revisions

From Wikipedia, the free encyclopedia
Browse history interactively
← Previous edit
Content deleted Content added
VisualWikitext
Arinelle (talk | contribs)
99 edits
Add redirect hatnote
 
(47 intermediate revisions by 16 users not shown)
Line 1: Line 1:
{{redirect|Inverted uterus|a different orientation of the uterus|retroverted uterus}}
'''Uterine inversion''' is a potentially fatal [[childbirth]] complication with a maternal survival rate of about 85%. It occurs when the [[placenta]] fails to detach from the [[uterus]] as it exits, pulls on the inside surface, and turns the organ inside out. It is very rare.
{{Infobox medical condition (new)
| name = {{PAGENAME}}
| synonyms =
| image = InvertedUterus.jpg
| width =
| alt =
| caption = Complete inverted uterus
| pronounce =
| field = [[Obstetrics]]
| symptoms = [[Postpartum bleeding]], abdominal pain, mass in the vagina, [[low blood pressure]]<ref name=Bh2009/>
| complications =
| onset =
| duration =
| types = First, second, third, fourth degree<ref name=Bh2009/>
| causes =
| risks = Pulling on the [[umbilical cord]] or pushing on the top of the [[uterus]] before the [[placenta]] has detached, [[uterine atony]], [[placenta previa]], [[connective tissue disorders]]<ref name=Bh2009/>
| diagnosis = Seeing the inside of the uterus in the vagina<ref name=Mir2009/>
| differential = [[Uterine fibroid]], [[uterine atony]], [[bleeding disorder]], [[retained placenta]]<ref name=Bh2009/>
| prevention =
| treatment = Standard [[resuscitation]], rapidly replacing the uterus<ref name=Bh2009/>
| medication = [[Oxytocin]], [[antibiotics]]<ref name=Bh2009/>
| prognosis = ~15% risk of death<ref name=Gan2016/>
| frequency = About 1 in 6,000 deliveries<ref name=Bh2009/><ref name=Gl2008/>
| deaths =
}}
<!-- Definition and symptoms -->
'''Uterine inversion''' is when the [[uterus]] turns inside out, usually following [[childbirth]].<ref name=Bh2009>{{cite journal |last1=Bhalla |first1=Rita |last2=Wuntakal |first2=Rekha |last3=Odejinmi |first3=Funlayo |last4=Khan |first4=Rehan U |title=Acute inversion of the uterus |journal=The Obstetrician & Gynaecologist |date=January 2009 |volume=11 |issue=1 |pages=13–18 |doi=10.1576/toag.11.1.13.27463|s2cid=116580372 |doi-access= }}</ref> Symptoms include [[postpartum bleeding]], abdominal pain, a mass in the vagina, and [[low blood pressure]].<ref name=Bh2009/> Rarely inversion may occur not in association with [[pregnancy]].<ref>{{cite journal |last1=Mehra |first1=R |last2=Siwatch |first2=S |last3=Arora |first3=S |last4=Kundu |first4=R |title=Non-puerperal uterine inversion caused by malignant mixed mullerian sarcoma. |journal=BMJ Case Reports |date=12 December 2013 |volume=2013 |pages=bcr2013200578 |doi=10.1136/bcr-2013-200578 |pmid=24334469|pmc=3863018 }}</ref>

<!-- Cause and diagnosis -->
Risk factors include pulling on the [[umbilical cord]] or pushing on the top of the [[uterus]] before the [[placenta]] has detached.<ref name=Bh2009/> Other risk factors include [[uterine atony]], [[placenta previa]], and [[connective tissue disorders]].<ref name=Bh2009/> Diagnosis is by seeing the inside of the uterus either in or coming out of the [[Human vagina|vagina]].<ref name=Mir2009>{{cite journal |last1=Mirza |first1=FG |last2=Gaddipati |first2=S |title=Obstetric emergencies. |journal=Seminars in Perinatology |date=April 2009 |volume=33 |issue=2 |pages=97–103 |doi=10.1053/j.semperi.2009.01.003 |pmid=19324238}}</ref><ref>{{cite book |last1=Apuzzio |first1=Joseph J. |last2=Vintzileos |first2=Anthony M. |last3=Berghella |first3=Vincenzo |last4=Alvarez-Perez |first4=Jesus R. |title=Operative Obstetrics, 4E |date=2017 |publisher=CRC Press |isbn=9781498720588 |page=PT822 |url=https://books.google.com/books?id=JLzZDQAAQBAJ&pg=PT822 |language=en}}</ref>

<!-- Treatment -->
Treatment involves standard [[resuscitation]] together with replacing the uterus as rapidly as possible.<ref name=Bh2009/> If efforts at manual replacement are not successful surgery is required.<ref name=Bh2009/> After the uterus is replaced [[oxytocin]] and [[antibiotics]] are typically recommended.<ref name=Bh2009/> The placenta can then be removed if it is still attached.<ref name=Bh2009/>

<!-- Epidemiology and history -->
Uterine inversion occurs in about 1 in 2,000 to 1 in 10,000 deliveries.<ref name=Bh2009/><ref name=Gl2008>{{cite journal |last1=Andersen |first1=H. Frank |last2=Hopkins |first2=Michael P. |title=Postpartum Hemorrhage |journal=The Global Library of Women's Medicine |date=2009 |doi=10.3843/GLOWM.10138}}</ref> Rates are higher in the [[developing world]].<ref name=Bh2009/> The risk of death of the mother is about 15% while historically it has been as high as 80%.<ref name=Gan2016>{{cite book |last1=Gandhi |first1=Alpesh |last2=Malhotra |first2=Narendra |last3=Malhotra |first3=Jaideep |last4=Gupta |first4=Nidhi |last5=Bora |first5=Neharika Malhotra |title=Principles of Critical Care in Obstetrics |date=2016 |publisher=Springer |isbn=9788132226925 |page=335 |url=https://books.google.com/books?id=nf2uCwAAQBAJ&pg=PA335 |language=en}}</ref><ref name=Bh2009/> The condition has been described since at least 300 BC by [[Hippocrates]].<ref name=Bh2009/>

==Signs and symptoms==
[[File:The diseases of women - a handbook for students and practitioners (1897) (14775130271).jpg|thumb|Drawing of an inverted uterus]]

⚫
Uterine inversion is often associated with significant [[postpartum bleeding]]. Traditionally it was thought that it presented with haemodynamic shock "out of proportion" with blood loss, however blood loss has often been underestimated. The [[parasympathetic]] effect of traction on the uterine ligaments may cause [[bradycardia]].


==Causes==
==Causes==
Most common cause is mismanagement of 3rd stage of labor
The most common cause is the mismanagement of 3rd stage of labor, such as:
* Fundal pressure
* Fundal pressure
* Congenital weakness
* Excess cord traction during the 3rd stage of labor
* Excess cord traction during the 3rd stage of labor

Other natural causes can be:
⚫
* Uterine weakness, congenital or not
* Precipitate delivery
* Precipitate delivery
⚫
* Short umbilical cord
⚫
* Uterine weakness
⚫
* short umbilical cord
It is more common in multiple gestation than in singleton pregnancies.
It is more common in multiple gestation than in singleton pregnancies.


⚫
===Associations===
Incidence 1/2000 pregnancies

==Types==
⚫
*ONE: Complete. Visible outside the [[cervix]].
⚫
*TWO: Incomplete. Visible only at the cervix.<ref>[http://www.betterhealthchannel.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Uterine_inversion?OpenDocument Uterine inversion] - Better Health Channel; State of Victoria, Australia; accessed 2009-04-03</ref>

⚫
==Associations==
* [[Placenta praevia]]
* [[Placenta praevia]]
* Fundal Placental Implantation
* Fundal Placental Implantation
* Use of [[Magnesium Sulphate]]
* Use of [[Magnesium Sulfate]]
* Vigorous fundal pressure
* Vigorous fundal pressure
* Repeated cord traction
* Repeated cord traction
* short umbilical cord
* short umbilical cord


==Presentation==
==Types==
[[File:Pathology and treatment of diseases of women (1912) (14594979458).jpg|thumb|Incomplete (left) and complete (right) inversion of the uterus]]
⚫
Uterine inversion is often associated with significant [[Post-partum Hemorrhage]]. Traditionally it was thought that it presented with haemodynamic shock "out of proportion" with blood loss, however blood loss has often been underestimated. The parasympathetic effect of traction on the uterine ligaments may cause bradycardia.
⚫
*One: Complete. Visible outside the [[cervix]].

⚫
*Two: Incomplete. Visible only at the cervix.<ref>[http://www.betterhealthchannel.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Uterine_inversion?OpenDocument Uterine inversion] {{Webarchive|url=https://web.archive.org/web/20091004181325/http://www.betterhealthchannel.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Uterine_inversion?OpenDocument |date=2009-10-04 }} - Better Health Channel; State of Victoria, Australia; accessed 2009-04-03</ref>
==Management==
Principles of management are to treat the [[Shock (circulatory)|shock]] and replace the uterus. The patient should be moved rapidly to the OR to facilitate anesthesia monitoring during this procedure. Usually this complication is only recognized after delivery of the placenta, wherein pitocin has already been started, which just exacerbates the problem. The uterus clamps down around the inversion making it very difficult to perform a replacement. This is a true obstetrical emergency, so extra doctors, nurses, anesthesiologists should be summoned to the room to assist. The pitocin should be turned off immediately. Giving tocolytics such as terbutaline or magnesium sulfate have a lower success rate. Halothane and Nitroglycerine (100mcg to 200 mcg intravenously)have a higher success rate. Once you have achieved uterine relaxation, place your fist into the vagina. Find the biggest part of the inversion and push with your fist cephalad to replace the uterus. This takes firm '''steady''' force, so keep your fist in the vagina if you need to rest your hand. Then continue more force toward the fundus to replace the uterus. You can use your left hand on the outside of the abdomen to help you feel where the fundus should be replaced. This helps guide the angle of your fist in replacing the uterus. Once it is replaced, give the patient Misoprostol 1000 mcgs rectally to help with increasing uterine tone. Other medications such as Methergine and Hemabate can be used. If you have heavy bleeding, consider inserting a Bakri balloon into the uterine cavity to tamponade the bleeding.

These patients have usually sustained heavy blood loss, and should be monitored in the ICU postoperatively. If you have given nitroglycerine, they must have cardiac monitoring postoperatively.


==Treatment==
Other personnel should be monitoring vital signs, ordering blood products, assisting the anesthesiologist, drawing labs, and stabilizing the patient. Remember that nitroglycerine can cause hypotension, which can be reversed with ephedrine.
[[File:The Principles and practice of gynecology - for students and practitioners (1904) (14581562549).jpg|thumb|left|Manual replacement of the uterus]]
Treatment involves standard [[resuscitation]] together with replacing the uterus as rapidly as possible.<ref name=Bh2009/> If efforts at manual replacement are not successful surgery is required.<ref name=Bh2009/> After the uterus is replaced [[oxytocin]] and [[antibiotics]] are typically recommended.<ref name=Bh2009/> The placenta can then be removed if it is still attached.<ref name=Bh2009/>


==Epidemiology==
If external replacement fails, a laparotomy may be required, in which the uterus is gently pulled the right way round using forceps.
Uterine inversion occurs in about 1 in 2,000 to 1 in 10,000 deliveries.<ref name=Bh2009/><ref name=Gl2008/> Rates are higher in the [[developing world]].<ref name=Bh2009/>
{{-}}


==References==
==References==
Line 41: Line 78:


[[Category:Complications of labour and delivery]]
[[Category:Complications of labour and delivery]]
[[Category:Wikipedia medicine articles ready to translate]]

Latest revision as of 01:21, 18 September 2024

"Inverted uterus" redirects here. For a different orientation of the uterus, see retroverted uterus.
Uterine inversion
Complete inverted uterus
SpecialtyObstetrics
SymptomsPostpartum bleeding, abdominal pain, mass in the vagina, low blood pressure[1]
TypesFirst, second, third, fourth degree[1]
Risk factorsPulling on the umbilical cord or pushing on the top of the uterus before the placenta has detached, uterine atony, placenta previa, connective tissue disorders[1]
Diagnostic methodSeeing the inside of the uterus in the vagina[2]
Differential diagnosisUterine fibroid, uterine atony, bleeding disorder, retained placenta[1]
TreatmentStandard resuscitation, rapidly replacing the uterus[1]
MedicationOxytocin, antibiotics[1]
Prognosis~15% risk of death[3]
FrequencyAbout 1 in 6,000 deliveries[1][4]

Uterine inversion is when the uterus turns inside out, usually following childbirth.[1] Symptoms include postpartum bleeding, abdominal pain, a mass in the vagina, and low blood pressure.[1] Rarely inversion may occur not in association with pregnancy.[5]

Risk factors include pulling on the umbilical cord or pushing on the top of the uterus before the placenta has detached.[1] Other risk factors include uterine atony, placenta previa, and connective tissue disorders.[1] Diagnosis is by seeing the inside of the uterus either in or coming out of the vagina.[2][6]

Treatment involves standard resuscitation together with replacing the uterus as rapidly as possible.[1] If efforts at manual replacement are not successful surgery is required.[1] After the uterus is replaced oxytocin and antibiotics are typically recommended.[1] The placenta can then be removed if it is still attached.[1]

Uterine inversion occurs in about 1 in 2,000 to 1 in 10,000 deliveries.[1][4] Rates are higher in the developing world.[1] The risk of death of the mother is about 15% while historically it has been as high as 80%.[3][1] The condition has been described since at least 300 BC by Hippocrates.[1]

Signs and symptoms

[edit]
Drawing of an inverted uterus

Uterine inversion is often associated with significant postpartum bleeding. Traditionally it was thought that it presented with haemodynamic shock "out of proportion" with blood loss, however blood loss has often been underestimated. The parasympathetic effect of traction on the uterine ligaments may cause bradycardia.

Causes

[edit]

The most common cause is the mismanagement of 3rd stage of labor, such as:

  • Fundal pressure
  • Excess cord traction during the 3rd stage of labor

Other natural causes can be:

  • Uterine weakness, congenital or not
  • Precipitate delivery
  • Short umbilical cord

It is more common in multiple gestation than in singleton pregnancies.

Associations

[edit]

Types

[edit]
Incomplete (left) and complete (right) inversion of the uterus
  • One: Complete. Visible outside the cervix.
  • Two: Incomplete. Visible only at the cervix.[7]

Treatment

[edit]
Manual replacement of the uterus

Treatment involves standard resuscitation together with replacing the uterus as rapidly as possible.[1] If efforts at manual replacement are not successful surgery is required.[1] After the uterus is replaced oxytocin and antibiotics are typically recommended.[1] The placenta can then be removed if it is still attached.[1]

Epidemiology

[edit]

Uterine inversion occurs in about 1 in 2,000 to 1 in 10,000 deliveries.[1][4] Rates are higher in the developing world.[1]

References

[edit]
  1. ^ a b c d e f g h i j k l m n o p q r s t u v w x y Bhalla, Rita; Wuntakal, Rekha; Odejinmi, Funlayo; Khan, Rehan U (January 2009). "Acute inversion of the uterus". The Obstetrician & Gynaecologist. 11 (1): 13–18. doi:10.1576/toag.11.1.13.27463. S2CID 116580372.
  2. ^ a b Mirza, FG; Gaddipati, S (April 2009). "Obstetric emergencies". Seminars in Perinatology. 33 (2): 97–103. doi:10.1053/j.semperi.2009.01.003. PMID 19324238.
  3. ^ a b Gandhi, Alpesh; Malhotra, Narendra; Malhotra, Jaideep; Gupta, Nidhi; Bora, Neharika Malhotra (2016). Principles of Critical Care in Obstetrics. Springer. p. 335. ISBN 9788132226925.
  4. ^ a b c Andersen, H. Frank; Hopkins, Michael P. (2009). "Postpartum Hemorrhage". The Global Library of Women's Medicine. doi:10.3843/GLOWM.10138.
  5. ^ Mehra, R; Siwatch, S; Arora, S; Kundu, R (12 December 2013). "Non-puerperal uterine inversion caused by malignant mixed mullerian sarcoma". BMJ Case Reports. 2013: bcr2013200578. doi:10.1136/bcr-2013-200578. PMC 3863018. PMID 24334469.
  6. ^ Apuzzio, Joseph J.; Vintzileos, Anthony M.; Berghella, Vincenzo; Alvarez-Perez, Jesus R. (2017). Operative Obstetrics, 4E. CRC Press. p. PT822. ISBN 9781498720588.
  7. ^ Uterine inversion Archived 2009-10-04 at the Wayback Machine - Better Health Channel; State of Victoria, Australia; accessed 2009-04-03
Retrieved from "https://en.wikipedia.org/enwiki/w/index.php?title=Uterine_inversion&oldid=1246288323"