Uterine inversion: Difference between revisions
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| field = [[Obstetrics]] |
| field = [[Obstetrics]] |
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| symptoms = [[Postpartum bleeding]], abdominal pain, mass in the vagina, [[low blood pressure]]<ref name=Bh2009/> |
| symptoms = [[Postpartum bleeding]], abdominal pain, mass in the vagina, [[low blood pressure]]<ref name=Bh2009/> |
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| differential = [[ |
| differential = [[Uterine fibroid]], [[uterine atony]], [[bleeding disorder]], [[retained placenta]]<ref name=Bh2009/> |
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| treatment = Standard [[resuscitation]], rapidly replacing the uterus<ref name=Bh2009/> |
| treatment = Standard [[resuscitation]], rapidly replacing the uterus<ref name=Bh2009/> |
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Revision as of 21:40, 3 October 2018
| Uterine inversion | |
|---|---|
| Specialty | Obstetrics |
| Symptoms | Postpartum bleeding, abdominal pain, mass in the vagina, low blood pressure[1] |
| Types | First, second, third, fourth degree[1] |
| Differential diagnosis | Uterine fibroid, uterine atony, bleeding disorder, retained placenta[1] |
| Treatment | Standard resuscitation, rapidly replacing the uterus[1] |
| Frequency | About 1 in 10,000 deliveries (US)[1] |
Uterine inversion is when the uterus turns inside out following childbirth.[1] Symptoms include postpartum bleeding, abdominal pain, mass in the vagina, and low blood pressure.[2]
The most common causes are pulling on the umbilical cord or pushing on the top of the uterus before the placenta has detached.[2] Other risk factors include uterine atony, placenta previa, and connective tissue disorders.[2]
Treatment involves standard resuscitation together with replacing the uterus as rapidly as possible.[1] If manual replacement is not effective surgery is required.[2] After the uterus is replaced oxytocin and antibiotics are recommended.[1] The placenta can than be removed if it is still attached.[1]
Uterine inversion occurs in about 1 in 10,000 deliveries in the United States.[2] Rates are higher in the developing world.[2] The risk of death of the mother is up to 80%.[1] The condition has been described since at least 300 BC by Hippocrates.[2]
Signs and symptoms
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
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
- Placenta praevia
- Fundal Placental Implantation
- Use of Magnesium Sulfate
- Vigorous fundal pressure
- Repeated cord traction
- short umbilical cord
Types
Epidemiology
The incidence is of 1/2000 pregnancies.
References
- ^ a b c d e f g h i j 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.
- ^ a b c d e f g Cite error: The named reference
-Bh2009was invoked but never defined (see the help page). - ^ Uterine inversion Archived 2009-10-04 at the Wayback Machine - Better Health Channel; State of Victoria, Australia; accessed 2009-04-03