INVERSION OF THE UTERUS
It is an extremely rare but a life-threatening complication in third stage in which the uterus is turned inside out partially or completely. The incidence is about 1 in 20,000 deliveries. The obstetric inversion is almost always an acute one and usually complete?
First Degree - There is dimpling of the fundus, which still remains above the level of internal os.
Second degree - The fundus passes through the cervix but lies inside the vagina.
Third degree (complete) - The endometrium with or without the attached placenta is visible outside the vulva. The cervix and part of the vagina may also be involved in the very after separation of placenta.
ETIOLOGY: The inversion may be spontaneous or more commonly induced.
SPONTANEOUS (40%): This is brought about by localized atony on the placental site over the fundus associated with sharp rise of intraabdominal pressure as in coughing, sneezing or bearing down effort. Fundal attachment of the placenta (75%), short cord and placenta accreta weakness of uterine wall at the placental site are often associated.
IATROGENIC: This is due to the mismanagement of third stage of labor.
Pulling the cord when the uterus is atonic especially when combined with fundal pressure -Fundal pressure while the uterus is Relaxed-Faulty technique in manual removal.
Common risk factors are uterine over enlargement, prolonged labor, fetal macrosomia, uterine
malformations, morbid adherent placenta, short umbilical cord, tocolysis and manual removal of
placenta. It is more common in women with collagen disease like Ehler-Danlos syndrome.
1) Shock is extremely profound mainly of neurogenic origin due to—
- a) Tension on the nerves due to stretching of the infundibulopelvic ligament,
- b) Pressure on the ovaries as they are dragged with the fundus through the cervical ring and
- c) Peritoneal irritation.
2) Hemorrhage, especially after detachment of placenta,
3) Pulmonary embolism
4) If left uncared for, it may lead to-
- a) Infection
- b) Uterine sloughing and
- c) A chronic one.
SYMPTOMS: Acute lower abdominal pain with bearing down sensation.
1) Varying degree of shock is a constant feature,
2) Abdominal examination- a) Cupping or dimpling of the fundal surface,
- b) Bimanual examination not only helps to confirm the diagnosis but also the degree. In complete variety, a pear-shaped mass protrudes outside the vulva with the broad end pointing downward and looking reddish purple in color.
- c) Sonography can confirm the diagnosis when clinical examination is not clear.
PROGNOSIS: As it is commonly met in unfavorable surroundings, the prognosis is extremely gloomy. Even if the patient survives, infection, sloughing of the uterus and chronic inversion with ill health may occur.
PREVENTION: Do not employ any method to expel the placenta out when the uterus is relaxed. Pulling the cord simultaneous with fundal pressure should be avoided. Manual removal should be done in a manner, as it should be.
HOMOEOPATHIC MEDICINES FOR MANAGING INVERSION OF UTERUS: -
- Calcarea Flour: - it is the best Homoeopathic medicine for treating problems related with uterus. It restores the elasticity of the smooth muscles in the uterus and helps to shrink any growth. In addition to this it also subsides the pain and heaviness of uterus.
- Belladonna: - it is prescribed in cases where the uterine troubles cause a lot of pain. If the pain causes a cramping sensation in the abdominal region.
- Sepia: - it greatly reduces the burning pains of uterus. It also reduces the bearing down sensation and protects against recurrent vaginal and urinary tract infections due to uterus enlargement.
- Phosphorus: - particularly helpful in cases where the woman has early and long lasting periods along with stitching pain in the abdomen and lower back region