Author(s): P. Thulasi1, Ramaraju H. E2, Bharathi K. R3, Rebecca Ratnam4
INTRODUCTION: Acute inversion of uterus is a rare but life-threatening complication of the third stage of the labour. The incidence varies widely between 1 in 2000 to 1 in 50,000 deliveries, largely dependent upon the standard of care of third stage of labour. It has been known as early as 2500 B.C as stated in a historical review by Das (1940). This says that there are passages in Ayurvedic literature (2500-600 B.C) which suggests that inversion was known to Hindus. It was Hippocrates (460-370 B.C) who is first credited to have recognized an inverted uterus.1
CASE REPORT: 25 years old P3L3 was referred from periphery with a h/o delivering a live male baby of 3.4Kg at 11pm on 30.03.2014 at a local hospital, where she collapsed due to heavy bleeding and sent to a CHC, from there she had been referred to us at P K Das Institute of Medical Sciences with the h/o Post-partum haemorrhage and mass per vaginum. When the case was first seen at the labour room she was in shock with B.P 90/60 mm of Hg and PR= 114beats/ min. Pallor ++, per abdomen finding revealed no palpable uterus. Per vaginal examination showed a boggy mass protruding in to the vagina seen at the introitus. Hence the diagnosis of acute inversion of uterus complete variety was made.
Wide bore cannulae inserted and patient was resuscitated with crystalloids and colloids and cross matched blood was obtained and started transfusion. Meanwhile attempts were made to reposition the uterus by manual and hydrostatic (O Sullivan method) but efforts failed due to the tight constriction ring of cervix over the prolapsed uterine fundus. Hence we resorted to abdominal method under General Anaesthesia. Laparotomy was done classical flower vase appearance of inversion i.e. fundus along with the infundibula-pelvic, round ligaments and ovaries were pulled in to the crater of inversion. Haultains method – incision given on the posterior aspect of the constriction ring followed by withdrawal of the fundus using Allis forceps as gentle stepwise manner done. Later the incision which is vertical was sutured. Post-operatively she received 2 pints of packed cells and other routine post –operative care and she was discharged on 7th POD with uneventful recovery.
DISCUSSION: A classical portrayal of inversion of uterus is given by Giffard, William (d. 1731). Cases in midwifery. Edited by Edward Hody (1698?-1759). London: B. Motte and T. Wotton, 1734.
The child was born about an hour before I came, and the midwife in attempting to bring away the placenta, had inverted the uterus; for upon examination, I found the whole body of the uterus with the placenta, adhering to the fundus, hanging out beyond the labia; there was a great profusion of blood, and the women was dead before I came... This case should be a caution to all practitioners how they attempt to bring away the placenta, and not to pull the string