title: Puerperal uterine inversion in the Netherlands: a nationwide cohort study.
abstract: Puerperal uterine inversion is a severe but rare obstetric complication of yet unknown origin. In this two-year study we determine the incidence of this complication and we describe associated risk factors to expose its etiology. All cases of uterine inversion were included from a nationwide cohort study which contained all 98 hospitals with a maternity unit in the Netherlands. We reviewed the medical records of 15 patients, resulting an incidence of approximately 1 in 20 000 vaginal births. Fourteen cases (93.3%) were classified as low-risk pregnancies at booking. Nulliparous women were not overrepresented and the main associated factors were signs of prolonged labor followed by third stage manipulation. This study is the first population-based study for uterine inversion. With the reported associated factors and occurrence in women with a low-risk profile, we show that every birth attendant should be able to detect this rare but severe complication.
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands. t.witteveen@lumc.nl
authors.forename: Tom
authors.initials: T
authors.lastname: Witteveen
authors.forename: Giel
authors.initials: G
authors.lastname: van Stralen
authors.forename: Joost
authors.initials: J
authors.lastname: Zwart
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D004420:Dystocia / Q000453:epidemiology; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D015994:Incidence; D007749:Labor Stage, Third; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011644:Puerperal Disorders / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors; D019687:Uterine Inversion / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D014710:Version, Fetal; D055815:Young Adult
chemical_list: D006454:Hemoglobins