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{{redirect|Inverted uterus|a different orientation of the uterus|retroverted uterus}}
{{Infobox medical condition (new)
{{Infobox medical condition (new)
| name = {{PAGENAME}}
| name = {{PAGENAME}}
| synonyms =
| synonyms =
| image =
| image = InvertedUterus.jpg
| width =
| width =
| alt =
| alt =
| caption =
| caption = Complete inverted uterus
| pronounce =
| pronounce =
| field = [[Obstetrics]]
| field = [[Obstetrics]]
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| medication = [[Oxytocin]], [[antibiotics]]<ref name=Bh2009/>
| medication = [[Oxytocin]], [[antibiotics]]<ref name=Bh2009/>
| prognosis = ~15% risk of death<ref name=Gan2016/>
| prognosis = ~15% risk of death<ref name=Gan2016/>
| frequency = About 1 in 6,000 deliveries<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}}</ref><ref name=Gl2008/>
| frequency = About 1 in 6,000 deliveries<ref name=Bh2009/><ref name=Gl2008/>
| deaths =
| deaths =
}}
}}
<!-- Definition and symptoms -->
<!-- Definition and symptoms -->
'''Uterine inversion''' is when the [[uterus]] turns inside out, usually following [[childbirth]].<ref name=Bh2009/> Symptoms include [[postpartum bleeding]], abdominal pain, a mass in the vagina, and [[low blood pressure]].<ref name=Bh2009/>
'''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 -->
<!-- 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 [[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.ca/books?id=JLzZDQAAQBAJ&pg=PT822 |language=en}}</ref>
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 -->
Treatment involves standard [[resuscitation]] together with replacing the uterus as rapidly as possible.<ref name=Bh2009/> If manual replacement is not effective surgery is required.<ref name=Bh2009/> After the uterus is replaced [[oxytocin]] and [[antibiotics]] are often recommended.<ref name=Bh2009/> The placenta can than be removed if it is still attached.<ref name=Bh2009/>
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 -->
<!-- Epidemiology and history -->
Uterine inversion occurs in about 1 in 2,000 to 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 it has historically 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.ca/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/>
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==
==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]].
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]].


Line 59: Line 62:


==Types==
==Types==
[[File:Pathology and treatment of diseases of women (1912) (14594979458).jpg|thumb|Incomplete (left) and complete (right) inversion of the uterus]]
*One: Complete. Visible outside the [[cervix]].
*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>
*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>

==Treatment==
[[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==
==Epidemiology==
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/>
The incidence is of 1/2000 pregnancies.
{{-}}


==References==
==References==
Line 69: 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"