Treatment of complete subacute postpartum uterine inversion: the case report

• DOI: 10.15574/pp.2024.98.115
• Publication Date: 2024-12-02T16:12:07Z
• Authors: I.L. Kukuruza; ; I.V. Shramko; ; A.V. Voznyuk; ; ; N.V. Tytarenko; ; ; R.M. Banakhevych; ; S.K. Litvinov; ; A.V. Belinsky; ; G.V. Bevz

Acute postpartum uterine inversion is a rare and unpredictable complication, usually in the third stage of labor, with the development of massive hemorrhage and shock, which can lead to significant morbidity and mortality. An even more rare scenario faced by the gynecologist is subacute uterine inversion. Most often, postpartum uterine inversion is caused by early or excessive traction on the umbilical cord and/or pressure on the fundus of the uterus before separation of the placenta (Crede maneuver) during the third stage of labor. The diagnosis is based on clinical data - the presence of a smooth round mass protruding from the cervix or vagina. When examining the abdominal cavity, the key finding is the absence of the uterine fundus during palpation in the area of its normal location. Management of postpartum uterine inversion includes: return of the uterine fundus to the correct position, prevention and treatment of postpartum hemorrhage and shock, prevention of repeated inversion. The aim is to describe the features of diagnosis and treatment of subacute postpartum uterine inversion of the IV degree. Clinical case. A report of a clinical case of subacute postpartum uterine inversion of the IV degree in a 29-year-old woman in labor, who was successfully treated using the Huntington's procedure and subsequent total hysterectomy with fallopian tubes, is presented. Conclusions. Given that acute postpartum uterine inversion is an extremely rare clinical phenomenon in obstetric practice, early recognition of this pathology is a difficult task, especially in cases of inversion of the I or II degree, when it can imitate a myomatous nodule. Although rare, uterine inversion should be carefully evaluated in any case of maternal collapse in the presence of signs and symptoms such as postpartum hemorrhage, lower abdominal pain, and/or the presence of a smooth, round mass protruding from the cervix or vagina. For the most favorable prognosis, not only early high-quality diagnosis is important, but also timely treatment in order to avoid the need for hysterectomy. In cases of subacute and chronic uterine inversion, surgical treatment should be considered, since the inverted walls of the uterus have reduced elasticity due to involution. This study did not involve any experiments on animals or humans. Written informed consent for treatment and publication of this case was obtained from the patient. No conflict of interests was declared by the authors.