[Acute puerperal uterine inversion: two cases].
Acute puerperal inversion is both rare and serious (1/20000 deliveries in France) and may lead to significant morbidity and mortality. Outcome depends on the degree of uterine bleeding and the presence or not of a state of shock. Acute puerperal inversion occurs at the time of placental delivery. Four stages are usually described by degree of exteriorization of the uterus. The diagnosis is essentially clinical. The predisposing factors are hypotonic uterus, fundal implantation of the placenta and placental acretas. 60% of all cases are caused by precipitous manoeuvres including traction on the cord or improper fundal pressure. Once a diagnosis is made immediate measures must be undertaken to assure clinical stability of the mother. Manuel reinversion of the uterus must be done quickly to avoid a cervical stricture that may form within thirty minutes of the inversion making successful manipulation very difficult. Failure or reoccurrence requires surgical treatment either by abdominal or vaginal approach. We report on two cases: one of complete inversion leading to a hysterectomy in order to control bleeding and a second case of incomplete inversion where repositioning was successful.
Miras
T
T
Service de Gynécologie-Obstétrique, CHRU de Saint-Etienne, Hôpital Nord, 42055 Saint-Etienne Cedex 2, France.
Collet
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F
Seffert
P
P
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015984:Causality; D005260:Female; D005602:France; D006801:Humans; D007044:Hysterectomy; D009017:Morbidity; D010120:Oxytocics / Q000627:therapeutic use; D010921:Placenta Accreta / Q000150:complications; D011181:Postnatal Care / Q000379:methods; D011247:Pregnancy; D011644:Puerperal Disorders / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D012720:Severity of Illness Index; D014143:Traction / Q000009:adverse effects; D016896:Treatment Outcome; D014470:Umbilical Cord; D019687:Uterine Inversion / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D014710:Version, Fetal / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D010120:Oxytocics