Authors: E. Pechová 1; I. Bydžovská 1; M. Krausová 1; M. Lubušký 2 Authors‘ workplace: Gynekologicko-porodnické oddělení, Krajská nemocnice, Liberec, primář MUDr. P. Černý 1; Porodnicko-gynekologická klinika LF UP a FN, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D. 2 Published in: Ceska Gynekol 2016; 81(5): 394-397
Objective: A case of acute inversion of the uterus after childbirth, in which we successfully perform a manual vaginal reposition of the uterus.
Design: Case report.
Setting: Department of Obstetrics and Gynaecology, Krajská nemocnice Liberec, a.s.; Department of Obstetrics and Gynaecology, Palacky University Hospital, Olomouc.
Observation: Our case report describes acute post-partum uterine inversion of the second degree, which developed after delivery in a 36-year-old primigravida. The placenta was not delivered despite uterotonics administration, use of the Credé manoeuvre and controlled umbilical cord traction. We decided for manual removal of the placenta in general anaesthesia. After successful removal of the placenta, uterine inversion was diagnosed. Therefore, we immediately started with vaginal reposition and the manual reposition of the uterus successful. Total blood loss amounted to approx. 2500 ml and the patient fell into the shock state. Severe coagulopathy was diagnosed using rotational thrombelastography. We were able to stabilise the condition of the patient and on the eigth day after delivery she was discharged home.
Conclusion: Uterine inversion is a rare complication of the third labour stage. Some obstetricians do not encounter this condition in their entire practice, but it can be cause of maternal mortality. Therefore, it is necessary that every obstetrician considers this possibility, knowing the risk factors and the therapeutic options in this critical situation.
Keywords: vaginal delivery, uterine inversion, peripartal life-threatening bleeding, maternal mortality
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