UTERINE INVERSION

Uterine inversion is the result of the uterine fundus collapsing partially or entirely towards the endometrial cavity and outward as a result of further internal and external rotation. Uterine inversion that occurs after birth should be urgently recognized and treated. Otherwise, it can cause bleeding and shock, which may lead to maternal deaths.
Uterine inversion can be divided into two main types:
- Puerperal uterine inversion: Occurs during cesarean section or normal delivery.
Non-puerperal uterine inversion: It is the inversion that occurs due to other causes such as myoma and polyp without pregnancy.
Approximately 95 percent of uterine inversions occur puerperally and 5 percent non-puerperal.
NON-PUERPERAL (GYNECOLOGICAL) UTERIN INVERSION:
Generally, fibroids and polyp in the fundus develop due to sarcoma-like pathologies. With the effect of the mass in the fundus, it results in pulling the fundus towards the vagina and causing its prolapse to the vulva completely inverted. It most commonly develops due to fundal submucosal myomas. In addition, polyps and malignancies can cause inversion. In the development mechanism of inversion, the tumoral mass in the uterus thinning the uterus wall under pressure and causing cervical dilation also plays a role.
PUERPERAL (OBSTETRIC) UTERIN INVERSION:
It is the uterine inversion that occurs after birth. There are different notifications about its frequency, such as one in about a few thousand births. It is called acute if it occurs within the first 24 hours after birth, subacute if it occurs between 24 hours and 1 month, and chronic uterine inversion if it occurs after 1 month. Most of it takes place within the first 24 hours. Inversion during labor can cause excessive pulling of the umbilical cord and excessive pressure on the fundus (Credé maneuver) (especially if the placenta fundus is localized and there is atony). Although it usually occurs at normal delivery, inversion may also occur during cesarean section.
On examination it is recognized by the emergence of the fundus from the cervix or vagina. In some cases, ultrasonography can also help in diagnosis. In the abdominal examination, the inability to palpate the fundus at its normal location is an important finding.
Classification according to the degree of inversion:
- 1st degree: The fundus is partially inverted towards the cavity, it has not passed the cervix.
- 2nd degree: Fundus is inverted enough to come out from the cervix.
- 3rd degree: Fundus is inverted from the vagina to the outside.
- 4th degree: The uterus, cervix and vagina are inverted to the outside.
It is important to perform obstetric uterine inversion treatment rapidly otherwise complications such as severe bleeding and shock may develop. If the placenta is still not removed at the time of inversion, it is not recommended to separate it manually before correcting the uterus. Because it increases the risk of bleeding. It is recommended that uterotonic drugs be discontinued immediately. Otherwise, it will be difficult to correct the uterus manually. If manual correction of the uterus is unsuccessful in the first attempt, it is recommended to try manual placement again by giving the uterine relaxant agents. Tocolytic agents, general anesthesia, nitroglycerin are used for relaxation of the uterus. In cases that cannot be restored manually, there are operations that can be performed vaginally and abdominally.
After placing the uterus in its normal position, it is recommended to start uterotonic drugs to prevent recurrence of inversion and atony. For this purpose, agents such as oxytocin, misoprostol, dinoprostone, methylergonovin are used.


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