title: Uterine inversion after an unskilled delivery - still a concern for maternal mortality: A case report and discussion of the related medico-legal issues.
abstract: Uterine inversion is a life-threatening medical emergency, which can result in fatal shock and sudden unexpected death during and after delivery. Most cases of uterine inversion occur due to mismanagement of the third stage of labour. We report a case of sudden death occurring post full-term vaginal delivery conducted by a traditional birth attendant (TBA) popularly known as dai. Autopsy revealed signs of haemorrhage and shock due to an inverted uterus. This emergency medical condition, though frequently fatal, can be treated if prompt action is taken by a trained and skilled obstetrician, preventing morbidity and mortality. We discuss the incidence, aetiology, symptomatology, complications and the management of uterine inversion. We also review the capability and eligibility of TBAs in handling such obstetrical emergencies, along with their culpability, if any, in such cases of negligence as per the applicable statutes.
authors.affiliation: Department of Forensic Medicine and Toxicology, Maulana Azad Medical College, New Delhi, India monishapr@yahoo.com.
authors.forename: Monisha
authors.initials: M
authors.lastname: Pradhan
authors.affiliation: Department of Forensic Medicine and Toxicology, Maulana Azad Medical College, New Delhi, India.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Barwa
authors.affiliation: Department of Forensic Medicine and Toxicology, Maulana Azad Medical College, New Delhi, India.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Baraw
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007194:India; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008880:Midwifery / Q000331:legislation & jurisprudence*; D006473:Postpartum Hemorrhage; D011247:Pregnancy; D012771:Shock, Hemorrhagic / Q000209:etiology; D019687:Uterine Inversion / Q000209:etiology*
keywords: Forensic pathology; autopsy; medical negligence; post-partum bleeding; traditional birth attendant; uterus inversion