A case report: Acute puerperal uterine inversion - ThaiJo

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A case report : Acute puerperal uterine inversion

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Abstract

A 27

^years

old

^pregnant

woman had

severe

lower Abdominal pain

with

hypovolemic

shock

due to

acute puerperal

uterine

inversion

which was the

rare incidence. Acute puerperal uterine inversion was found

in

adherent placenta, abnor-

mal

uterine contraction, placental removal ,increased abdominal pressure, incorrect care

in

3'd stage

of

labour and given magnesium sulfate intramuscular or intravenous.

Johnson ,Henderson and

Alles's

maneuver was done

without

any complication. The patient was safely discharged on the

fifth

day after admission.

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irlri'ufi hypovolemic

shock

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tutugr"riurn sulfate mr.rnflrurdo

rio

mtluaoprrdoflrir

'lffilnr:inutlnunt:r,t"'uuqannd'urflt'hjluantnrlnfr

IfluiBro.r Johnson Henderson and Alles

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(acute puerperal

uterine inversion

:

incompleted type) ^('-t)

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0-18'o) yr-rfifiu Acute puerperal uterine inversion

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rr:fi

onr nr:Fri'rod r{n'ru]oudr[6uer

o;drlJr:0 uunRirydoonliltd 1un:rifi lri

ruillolunr:ifr os:'uolnnt:et:'loii{ntfl Iou tovn;lu

incomplere

type nt:1{

abdomi-

nal

ultrasound('''

l4io MRI"t" gt:iooili'lu

-,v, "tc 3-

tun

t: lu iqu tgtulJuu'tu.tlJu

,.t]Jlu:tuutJ

01fl l: [td:n ]:9li I

i?tultyo .l- t0u ltl tl4dtrt:n

lu0f,u tot10 r:1

nr:,iruunyfi

olo{t.loan

auyii'{naoq

o ,ne i - ^L

0'10 0

|ttun toFtt :yuyt?dtyt[nqsufltr11.t .. -,, -9,,,, tuoifl to

_o.:u"

''

L

Acute puerperal uterine inver-

. ,{

sion uoan fiurfrori'ufryion rulu

24 rir JS

hruain noo

ua:"hin t:-ifr of,'u1fi1ur6uyfi

contraction ring

o-l'lilr.rofoo"'r ra-.r

rriu

1u ru

tu:tuxl

2.

Subacute puerperal uterine inversion roan:Jduri'1#nr:ifr osi'uldfi a-{orn 24

(7)

.i":Iu.:yainaosr urid.:lrin'I + d'rlon{ 6lfi

fl1:1Jq:Ofl'110.1 contractron

nng

UA'l

3. Chronic

puerperal

uterine

in-

version roan durfiouurunir + ailqrd

fio-nnaoo

u 0 fl 01 n u u,l 01 ttt-l nxu9l 9t1t] ft ?1 1l

^ J - ,.,,, :UU:.110.in]:tnOnll:u nrl

^-

"'

l. First

degree (incomplete) in-

v er:,,

ion uoo oan

aua.rilrrLeid{'[ilr.itu

urfl ,il

odn ^6r,r1,ul

[uHI'ru:ruu

2.

Second degree

inversion

uoo

Noanilauilruilrn oana{

1od'ludo{naoo

riluvfrsrfiurtfiriou (foua;

73)

3.

Third

degree (complete) inversion uoor.roanlr{rifruriornaosroonlr

4. Total inversion fidrutolruri':

$a{naao1 lauaafl lJtt'ttJo1fl

,,c

vdndrri'rXlunr:inlrnr1i oan

au

Iauuv{au a{na0on0

fl1::nu1R1']vYonvcl

Io fl

nr:l?iar:ilrilio

r6oo o tir

r::o

rEr ua

;

t1,{u l1^10

il nunt:uTJoanfluauo0n J,3

tnau

eisiruuil.riln6luriufi

otirrrrrrvau lufiriro

{ ,,.

:1UU

rul1tna00 ton:1n1{rtta;

t nt:1uof,u

,," -<t^ .""".

^y

t0

tullu 1ltflft

n{ lfl tfid t:ulYl'l{11a00 ^ta00

,, a-

orlrull 2 rdutv{0:fl!tnt1:10n tfuv r6urniu6\fuordoolr}1fi{ru z ufrfl l#ur

::.iuar

^tuYf;n

ttur

seneral anesthesia ]ou

'l{

endotracheal tube

rirflfitulo ftnt:riu

uoanndl

r{r'h.J1udn

ry{ilnA

Io o1#i6t o.r

Johnson('t)dr

niucJ

o.! Henderson

ttoy Alles(re)

nrin6o

rfi ol#fi ooiuuoqiloanl#aou dul:Jarn ^jr:yqixro r ard o rrt

o1#

Iigamenr

i o aA

flt{ 1

nno{:nnugt,l Igt

1l

uterosacral

rIai

i- , -Y

cardinal ligamenr

riuq

rnrLnan"[i

oydlf.:

rirucir.:1fl

rfl rnuoranoonlillfin5r{dufi

_ay

v i i-

1.10U tl.l0 round llgament 11gto 0UU: [16U tn A

.v"'/- c , *"-"-

u0otJoaflflno{:{ lt4Fr.ttJtnlu nysluo.r: r

tt i 9,,

uoouoan

rndou{u'lil tru;rdurniurfi or}n

" 3 """"

gannnnt{tUtU hln't'l.ltu tfi

tf

oval forceps

i -v,

oi:l rnuoan ulonr:o*rfrrjrnruoan'[5 uat

rrJoour.ru.!rJfl

I,

an rr r ruorJ

tuanrflilnfrrrdr lfi

4 t-

tJ0Ylfiuzuu.luoannt

tl

[u[1,!:.t

oan

^0ufl11

lJodfllJfl r:l.to:onto:

l

^nunl) ^t14oxylocin 0.t

tolfi

ooonornb'l:i oanqtrGnr:to.r

^Harris('ur

'tn _n

t:ut

ruu.ttJoanna!

[t

^Id9n

tt]lu{

r.lnfr

uonorni6ntto.r

Johnson

drunirtor

Henderson ua: Alles fi rtijufi fr uut[ny'lfi ruad ovc .. a 4 l-

1l I tgr{ lu ua: lxdtt:0 turuu]u:t uuo{fl a t'l ttd'l u H

tlu:u'l t']0flfialu'lD tlu 1nflt:10i o'sull ivan('u) {i.rlirir

r'iru

r{ru rfir15 tuno{n

ⁿ00 tvi

il

0 [1,t

n1I outuY0.tFld00

(srerile

douche) uono

rnfufifi:

^ruar t6 uo .l< e

1] rl {'l fi fl l: T l.l ,.,1 ttu:l1'l O l.:

qnU

tXUlnnl:10

i

Bunke

tra: Bellt'" tflufiu i"

uJ0ut

oanndu[1tdgt ru?luiunnrla r

910{ tt4utn::ftunt:Y9r:fi0t ^11,0^itJ9

an

n: ^v9lu

i

^{rz ruuii}^z

rqun rn& Rrrla&

2545

ttu,ttuir|t|

:

nttzua4nliurduuwiu"Uu!::n

__ El

(8)

@

ortuoi ti.u$ryilufina

'l'r- 611,n1lln{vtti 1:'rnu, uraaid;rnu .liuvri uiSNd

ovd r < r 4

[?rtJfl

1:ila:fl

9r?10{}Joon n 0u0 in0 u ^6lt0

lu0

o on o'r nlv{ :l}J fl a _!n rfi ori:

ulunr:#ru

^{16 o}^o

rua vilo{riunr:rfr q#rtruvd rorfi

ooon"''"'

^uau

rir

bimanual uterine compression

rirulu

n r :?r o io ri"r 1 o.: il o a n u n v#r u r 6 o q _dr il ff ? u'''t

"

r < - i,o^^ , '

ruiu rd u'ui'ufi ilfr u61u (:-h uil ^u^fi

'lfflfr

_oxytoc_in

<o<i

1l'1.:fi a 0 q ra 0fl fit9r a0 ^qt? a1 0 n

:v

^uv14u{

uonotnnt:'[# oxytocin drug rtfrrnr:'lfr prostaglandin

F2

alpha

ttio methyl

analogue (prostin

l5 -

M)(*) mto prostaglandin E2

V u u nY<r)lr

dtut:CIn:v grunt:ff _t! 9r:919r?10{}Jfl an toa ^--' nr :1#rr:Jfr

firu

; rfi o fllo r d'unr:fr n

& - Y d df, ' u 4

t50fi4{na0fluu iln?t}Jt14ultttflnflt{nu il

Y vA a v ihr{rr vA a r n Inv ^r

m{ruilH4UO?U

_!U ttorr{Yrt14U?lttJ t9rT?UA9r

X a t d q o q ,x,

o n:'lnt:elo ryofia {nao oa.:o dr.rfiriudrri'ru("'

o tjr.r'[:fi

orr

^{(rJr u:r}

odtfifrL

^u^r^rJ6'fi1u

r

- Av' - -

^C

ila{n a 0q ty,l0]J0.:nunl:9r0 tTo

v u't

{:t

u.:tuvtulo nt ant'l vil fl

anilau

a'

r d u

r

w ii'u n ai'.r n a o

q,ir1fflu

_n_{: : iisi}

01il

6.r Yo u a

r

44(u) 6.:1#n:

u

r#ui r'lrin r : #.r n

::ri sio1:l

usi:r

urru6irulr,rnivr:rirkilff rflu

rlrynr oionr:naon'[un::riuiol,],,uio d-.t.:'[q(u)

lu

ytt X o.Y

,.tu?u:tuu n?:t14fl{n::ddohllfr ril:ty

v

d-r ril ^etIUI o.uJ 9t a n il a u r fl ^pro I n n 1 Tyi 1 n a o q : n fi el

ii

^nr:naofl

n#rsiol:l

^uumtifr

or:yripr:yi.rlu nr:lirnaoq:n

4v c i

il fi rauon:rru rff ufr uqrnsir r rYu'lunr:

(6.r'lrJ vwlu _{:-h^o:r ^u

d;'i

^{r n}^r^:rir^ri^o^uⁿ^r^:oiu

Y t. r I a 4

,..1u{iloa nna1J tfl I elnl ttfi

u{iln

nfi

:0n?:0

v U!

nr uild{R'r:ri'u arriurpra n nd'u

ufl: 6.:rirnr:

firr:nnruma'{ Iu,ulfi,nr^u'ir nr:aon:R

r o o Y a d 4 r67t S

n 0 u0 vl]'l t14 rfl 9t fl t : r?l u ra o fl lJ'I fl

"'

_to_u_tfl_v'l_t_v

adherent placenta tuY'jrnr:aon?noonriou

Y o dY

0saq1ul9110{n0ua{ mt liln1:9rur.ru{}Jfl an

v

nii'urir'tff.ir ufiu(' t)

rra vdrln:nqrr?o6i?ullo{:n A v rn9/ r 4 ro, r m d

Yl0l0n1{0u _s

t9r0ut{avt0u9r

0ut{

t:nfltilnt:

Yt

aon:noonriouliu

n?:n:ufi r rfi o'lff rEriuruff

ttyi-v

rJr uvrSo ufro

rdril

r:neriu r.'rriru qa nnaiu

r{rd

pir urrirrJnfr

lurTufi

^Tnu royrr vo

tirr0rnr:

@ d tit y d yb d n ruy

fltta:nulnllvTon "

fl-lu{ttn t6ljnt'l;s0n til t9t

v a - y A c l

14ll.t9tUilOAnnAU _! t1't1l tOOl-l9t tUl:',t30 ^ytl tl.t

n2ril 15uil'roouri rt#ff:-h _v u rfi ufiisr'tff("' nr:pi'u

v u Y A, Y 4 v

ilqany{T0}J:fl fl

autltmn0u rra'10{a'l{:n

o

0nrJr

6.rTr urn'rlrj rrfrr:n o yo _{o n}ilrTg u

ir

u

or <in, u y

tu n :

iult

^tlJdt lJl :ft 9tuil fl a

nv{:0il:n

fl

dx r{rl:Jlfr

6r,ir rfl uffo.r ror:n o on riou(3"5'I ²⁾

n1:r,r"'uilfl annei'l

rflrfi

:J:ynoufrr u

U

v

'liueroudrr

1'lffrrri('' nr:firt#

conrracrion ring nar ur;t''rlrr uorotfr

urdal

halothane ff10 tocolytic drugs triu magnesium sulfate

uto

beta-sympathomimetic drugs't''') r1rJru:ru

d l*trriJufforlfi tocolytic

drugs

ru:ryrir

'lrifi contraction ring tun:fifilfrr,rururrJ

pi'u u o a nlq ui6 n i : sr-r n ci r : fl r.r fr u u fl .lhi

d r rE o

Y dv t a v

60.r"[6nr: r.irqriqdl

ufir'lffviwrrriolna

o fl ua

r

a o n : n o o n o I n mil ru q a _Un'lu n : tivr' : n f,.r'lil a o n d'r

(9)

tii

rz ar;uii z

rqunloN , _RflrmN₂₅₄₅

4 _x

1l l.lYUl11(l

i tqU0l0tn?nfll:or

qAnnaUlUtJI rriu

i6tol

Haultain, Spinelli, Huntington(2') ySosr-ewoanoon'[r](t)

lufiil:u:rud

rfi o{orn

:u0flutft[:1 urt Ino con(raction ring nd'lorntdufl'ltnt1:6onufi2

ldoiurusran

- v.l . -. i.,,

n

ii'l r{

rfr air rSolo ufi fi rJ I u rfi urfi

oeril::il

r6u I .000

ila.

Ioua:iluf,

: yahnr:drrirulun

_r:oua

- '{ c

: n u I n I

l

rlJ o an u a u [f, uul,t aufi 6i {n d 0 0

::noufilu'"'''"' nr:lfin r:ifr

odu'l6otirlnn

90.!rrdr:19r[:]

ec! n

t:otta:nuln t?yron

nt:tt4

.t <"

uti;{un1t :dfllty{0tylu.:tunl:quflu{

oan nautfl tdsn rH4u.::Jna Lta; aseplic technique

:rl

^ri'r

nr:lfi prophylactic anribiotic

ie, - - {

[1't01J0{nun t:fto t10?1a{n

a0o

0ut{ t:nF]'ltt

R',l'lrudllJt:fl]J0{nuto x-

fi ]n t{T ]n a 091 ts

n'r :!lio:;i{rrar:oInollunr:frnaoo

louranrftu::t,r;fr )

3 To.:flrsn doq

/* o y C,

nttl,tutntfu t:fr tur.rrJrrJ:ruun0ulr

i0

rfro d. r

otnrirlrur?u16on'[riurn d] r:noiu

- s )ava -

qdnnnUtfllfl t9lt:1 tnOnlll$rln t

^UlXl

tta: t nt:9loIx0[t -{ :n,r0u dt11:lJn]:

fl

ord'unrr:roanil6uarlr:nrhtfr

lo 01il a0u tfin

t50a0oluuutu JJ

0ufl5:lt.:tJ ^onfll't9]

:o9r1

tlJfl t?una001lttn0ur{flnli

^rrav

rirnaoo:nlouiB

Brandt - Andrews maneu-

I ,X"

ver 0uIa00nu lLa: tdfl tn0nt t:lJoanuauu0 u r.r6n rd

urnr:rirnaoo:nlqui; cord

traction

l[n;

Crede's maneuver(t' fia'{naoo:nn:ydu

'[rl

Franfioinsr-r ua rfl:? odRlylrqa nfliufi

1qe1 . u A

11r0 rY

flt t:ftlu

0fluR t?: [[T:nry0uT0 ] 0 rna

flulta:d]t.l1:oufl tI

to tog r:']

I

6I: U

frrJruorq zz

fl

sry.:n::rid 2

orrrn::r{

+t firlnrri naoolq06u ldnr:nunrantll

drfifn

3,300

niu uilu:16 rirnaoo:nlou

i6 modified

Crede's maneuver LLa; con-

trolled cord traction tfiofltlr oan

au [duuyldiuy.i'{n ^a

ofl lfinr:fnu rlo0eiu

oan

nii'rr{rfi Iooi6toi Johnson drurillo.l

Henderson

ltd: Alles lfiiir15o lilfinr':y

lur:ndouya-{naoo frrh

uotil:lu utrlra

5

iu

nrier:1oer^oFn

ffa-{naon 6 drlorrl'lilr.r:t ornrifroiln6ln

₁

fisr6n::rud:vnrn

1ofloun uy{.toa Y'u ry6ilyludl

fidruronr:I:rlrurrlralifild

yiru.l\ ou1

n0{t.:u fil?tutfla

':11.ld9rn::

- u:[?5n::

" .- a .l

t:{yltJ 1!

ldU)-:tJU

Yl01-lfUl9ltYT lnlTflnU ^I

rrair urry{ir{airuluni.rfi rlayrororn6u

,, ,, A,, V YA<

Ilr11.1Ul1lYA{FraaO tta

y

IO1l.tU11l9tfl dfl

-Ui

, ld,

Lrsn::lJyrnyi'rullurirurir orviiolun r:finu'l

n:{u

(10)

@

^ortuoit!'u$rydudqa

Trldllnllltrvtu

1: trururRniarlnu qiuvt'i r1iiNti

6r.r6.r

l.

Van Vugt PJH, Baudoin P, Blom

VM,

Van Deursen

CThBM.

Inversio uteri

puerperalis. Acta Obstet

Gynecol Scand 1981

; 60 :353 -

^62.

2.

^Kapemick^PS.Postpartum hemorrhage

& the abnormal puerperium In

^:

Pemoll

ML,

Benson RC, eds. Current obstetric

&

gynecological diagnosis

& treatment. 6 th. ed. Norwalk.

Connecticut : Appleton

&

Lange,1987

:

524

-

40.

3.

dll?nJru

qid?::rr{.

uoqnrJfr'una-nnaoq.

lu :

6til14ilru

q.:q?::tu, u::illBnr:.

nr?ranrauilr.:qrr - uirrry. firdnYrid

l. In:rnr:drrrfi?:lx

fl:.rrYrYlill4run: ^:

s a da

t:ryiruyry,i+rrufl, 2524

:

281

-

6.

4.

Catanzarite

VA, Moffitt KD,

Baker ML, Awadalla SG, Argubright KF, Perkins.

New approach to the management

of acute puerperal uterine

inversion.

Obstet Gynecol 1986

; 68 :

^7s

-

10s.

5. Lipitz

S, Frenkel

Y.

Puerperal inver-

sion of the uterus. Eur J

Obstet Gynecol Reprod Biol 1988

;27

^{:271 -}^4.

6.

Watson

P,

Besch

N,

Bowes

WA

Jr.

Management

of

acute

and

subacute

puerperal inversion of the

uterus.

Obstet Gynecol 1980

; 55 : l2 -

^6.

Kitchin

JD, Thiagarajar S,

May HV,

Thomton WN. Puerperal inversion

of

the uterus. Am J Obstet Gynecol 1975

:123 :51 -

^8.

Cunningham FG, Leveho KJ, Gilstrap

LC,

Hauth JC, Wenstrom

KD,

Gant

NF. William

obstetrics.

2l th.

^ed.

Norwalk,

Connecticut

: Appleton &

Lange, 1991

:25 :

⁶⁴²

-

^3.

Platt

LD,

Druzin

ML.

Acute puerperal inversion of the uterus. Am J Gynecol

l98l;l4l:187-90.

Harris

BA.

Acute puerperal inversion

of the

uterus.

Clin

Obstet Gynecol 1984 ^'.

27 :

¹³⁴

-

8.

Wendel PJ,

Cox SM.

Emergent ob-

stetric management of uterine

inversion. Obstet Gynecol

Clin

North

Am

1995

;22:261 -

^74.

Quilligan EJ, Zuspan F.

In

: Douglas - Stromme Operative Obstetrics. 4 th.

ed. New York : Appleton

-

Century ^-

crofrs,

1982

:764 -

70.

Rachagan SP, Sivanesaratnam

V,

Kok

KP, Raman S. Acute puerperal

inversion

of

the uterus and obstetrics emergency. Aust NZ J Obstet Gynecol 1988

; 28 :29 -

32.

1.

8.

9.

10.

11.

t2.

13.

(11)

td

rz ar;uii z

NqunlnN - firurnr 2b4b t tu't tutitl tu : n 1 73 Nn dnil Aut flu un a'uu itna aa

EI

14.

15.

16.

11.

Gabbe SG,

Niebyl

JR, Simpson JL.

Normal

and problem pregnancies. 2

nd. Ed.

Churchill Livingston, l99l

;

18:599-600.

Hsieh TT, Lee JD.

Sonographic

finding in acute puerperal

uterine inversion.

J Clin

Ultrasound

l99l

;

19:306-9.

Lewin

JS, Bryan PJ.

MR

imaging

of uterine inversion. J Comput

Assist Tomogr

t989 ;

¹³

: 57 -

9.

Brar HS,

Greenspoon JS,

Platt LD, Paul RH. Acute puerperal

uterine

inversion : new approaches

to management.

J

Reprod

Med

1989 ;

34 :173 -

^7.

Johnson

AB,

^Rockaway

F. A

^new

concept in the

replacement

of

the

inverted uterus and

a

report

of

nine cases.

Am J

Obstet

Gynecol

1949 ;

57:557-62.

Henderson

H, Alles PW.

Puerperal inversion

of

the uterus.

Am

J Obstet Gynecol 1948

;56 :

¹³³

-

^42.

O'Sullivan JV. Acute inversion of the uterus.

Br

Med

J

1945

:2 :

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Bell

JE

Jr, Wilson GF, Wilson LA.

Puerperal inversion of the uterus. Am

J

Obstet Gynecol 1953

: 66 : 767

^-

80.

Thiery

M,

Delbeke

L.

Acute puerperal uterine inversion : two-step management

with

a beta

-

mimetic and a prostaglandin.

Am

J Obstet Gynecol 1985 ;

153

:891 -

2.

19.

20.

21.

22.

18.