Postpartum uterine inversion

Postpartum uterine inversion is a rare but extremely dangerous complication that occurs after childbirth. According to medical studies, its incidence ranges from 1 to 20 cases per 20,000 births, highlighting its exceptional nature but the necessity to be prepared to recognize it quickly. It is associated with a disruption of the uterine contraction process or errors in managing the third stage of labor. This condition requires immediate medical intervention, as it can have serious consequences for the woman's health.

What is postpartum uterine inversion?

Uterine inversion is a rare obstetric emergency in which the uterine body turns inside out and protrudes into the vagina or beyond the vaginal introitus (comes out of the cervix). Normally, after childbirth, the uterus should contract and return to its initial size. However, in this complication, uterine atony leads to its inversion.

Causes

The main causes of postpartum uterine inversion are related to a disruption of the normal uterine contraction process:

1. Uterine hypotonia. The decrease in uterine tone prevents the uterus from contracting normally.
2. Obstetric manipulation. Excessive pressure on the uterine fundus during the expulsion of the placenta.
3. Anatomical characteristics. In particular, weakness of the uterine ligamentous apparatus.
4. Short umbilical cord or strong tension behind it during labor.

Symptoms

Postpartum uterine inversion presents pronounced clinical symptoms that generally allow for a quick diagnosis. However, in rare cases, the diagnosis can be difficult to establish due to atypical manifestations such as hidden bleeding or the absence of marked pain, necessitating close attention to the overall clinical picture.

• Uterine bleeding is abundant and sudden.
• Severe pain in the lower abdomen - occurs immediately after childbirth.
• Feeling of a foreign body in the vagina - in cases of complete uterine inversion, the uterus may be palpable in the vaginal area or even visible.
• The woman's state of shock, manifested by pale skin, increased heart rate, and decreased blood pressure.

To confirm the diagnosis, the doctor conducts an examination. He assesses the shape and position of the uterus and may also use ultrasound to clarify the condition of the internal organs.

Treatment

Treatment of postpartum uterine inversion is determined by the severity of the condition, which is assessed based on the amount of blood lost, the state of the uterus (complete or partial inversion), and the presence of associated complications such as shock or infection. The main approaches are as follows:

1. Manual repositioning of the uterus. This is the initial and most common treatment method. The treatment consists of immediate manual reduction by pushing on the inner surface of the uterine fundus until the uterus returns to its normal position. Due to the pain caused, IV analgesics, sedatives, and general anesthesia are sometimes necessary.
2. Medication treatment. After repositioning, medications are prescribed:
   • Medications to contract the uterus (e.g., oxytocin).
   • Hormonal agents to restore uterine tone.
   • Antibiotics to prevent infectious complications.
3. Surgical intervention. If manual repositioning is impossible or unsuccessful, a surgical procedure is performed. The surgeon repositions the uterus to the correct position through the abdomen.

Complications and risks

If the treatment of postpartum uterine inversion is not undertaken in a timely manner, the following complications are possible:

• Uterine hemorrhage - can lead to severe anemia or hemorrhagic shock.
• Infections - associated with trauma to the uterine tissues.
• Infertility - due to damage to the uterus.
• Shock - a life-threatening condition for the woman.

Recovery

Recovery after postpartum uterine inversion requires a comprehensive approach. The approximate period for complete recovery can vary from several weeks to several months, depending on the severity of the case and the individual characteristics of the woman's body. The main recommendations are:

1. Regular medical check-ups. These are necessary to monitor the state of the uterus and the overall health condition.
2. Avoid physical exertion. It is important to give the body time to recover.
3. Healthy diet. The diet should include iron-rich foods (e.g., meat, fish, green vegetables) and vitamins.
4. Psychological support. Emotional exhaustion after a difficult childbirth requires special attention. It is recommended to communicate with loved ones and, in some cases, seek assistance from a specialist.

Uterine inversion is an obstetric emergency, and doctors should call for additional staff experienced in obstetric emergencies and anesthetists or operating room personnel, if necessary. Early recognition of symptoms and timely medical care can prevent serious complications and ensure the complete recovery of the woman's health.

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