Acute Puerperal Uterine Inversion: A 3 Year Study

Background: Acute puerperal uterine inversion is a rare but potentially life-threatening complication in which the uterine fundus collapses within the endometrial cavity. Although the cause of uterine inversion is unclear, several predisposing factors have been described. Maternal mortality is extremely high unless the condition is recognized and corrected. Methods: This was a prospective observational study, conducted over a period of three years from March 2012 to June 2015. The study included all the patients who developed acute puerperal inversion in the hospital or outside the hospital and were referred as a case of acute puerperal inversion. Patients of chronic puerperal inversion and non-puerperal inversion were not included in the study. Thorough abdominal and pelvic examination was carried out to confirm diagnosis and the observations were recorded. Results: A total of 71125 deliveries took place which includes 11 cases of puerperal inversion, the incidence being 1 in 6466 deliveries. More than half of the patients (54.54%) were multigravida. Majority of patients(81.8%) presented with features of moderate to severe shock. out of 11 patients in 6 the uterus was reposited back by O’Sullivan Hydrostatic method, two patients had to undergo hysterectomy one for morbidly adherent placenta and another for atonic PPH. In two patients the placenta could be reposited back manually and in one patient laparotomy was required to get the uterus back to its anatomical position. There was one maternal death out of 11 cases.