A CASE REPORT OF A PATIENT WITH AN ACUTE INTRAPARTAL UTERINE INVERSION
Date Issued
2025-09
Author(s)
Bekim Dika
Laureta Mena
Metodi Trajchevski
Abstract
Introduction. Acute inversion of uterus is a rare, but life-threatening complication of
third stage of labour. Uterine inversion is defined as the turning inside out of the
fundus into the uterine cavity. It’s incidence is 1:2,000–1:23,000 deliveries. Severe
uterine atony, mismanagement of third stage of labour, adherent placenta are some
of the common factors associated with the occurrence of acute inversion of uterus.
Case report. We report a case of the 25 years old primipara. After a spontaneous
delivery of the baby, during the controled cord traction, a mass appeared at the
introitus of the vagina. Placenta was still attached to the uterus. A complete uterine
inversion happened. Obstetric and anesthesia teams were emergency mobilized.
Manual uterine reposition under general anesthesia (the Johnson maneuver) was
performed 5-6 minutes after the event. The placenta was removed after the
repositioning of the uterus. Massive hemorrhage occured. Uterotonic therapy was
administered immediately after repositioning. The substitution therapy was
administered starting 25 minutes after the event and continued in the next 24 hours:
1400ml of erythrocyte concentrate, 880ml of fresh frozen plasma and 100ml 20%
albumine. The drop in the levels of hemoglobin and hematocrite 25 minutes after the
inversion was Hb=64g/L (121g/L antepartum), Hct=0.17 (0.33 antepartum). 72 hours
after the event this values were normalized. Vital signs were stabile, no further
hemorrhage occured, and woman was discharged at the forth post delivery day.
Conclusion: Early recognition and prompt treatment are important to save life of the
woman. Prompt recognition of uterine inversion, its immediate manual reposition
under general anaesthesia and transfusion of blood products are crucial for
successful tretment. Delay in recognition and treatment can result in haemorrhagic
and neurogenic shock, leading to death of a women.
third stage of labour. Uterine inversion is defined as the turning inside out of the
fundus into the uterine cavity. It’s incidence is 1:2,000–1:23,000 deliveries. Severe
uterine atony, mismanagement of third stage of labour, adherent placenta are some
of the common factors associated with the occurrence of acute inversion of uterus.
Case report. We report a case of the 25 years old primipara. After a spontaneous
delivery of the baby, during the controled cord traction, a mass appeared at the
introitus of the vagina. Placenta was still attached to the uterus. A complete uterine
inversion happened. Obstetric and anesthesia teams were emergency mobilized.
Manual uterine reposition under general anesthesia (the Johnson maneuver) was
performed 5-6 minutes after the event. The placenta was removed after the
repositioning of the uterus. Massive hemorrhage occured. Uterotonic therapy was
administered immediately after repositioning. The substitution therapy was
administered starting 25 minutes after the event and continued in the next 24 hours:
1400ml of erythrocyte concentrate, 880ml of fresh frozen plasma and 100ml 20%
albumine. The drop in the levels of hemoglobin and hematocrite 25 minutes after the
inversion was Hb=64g/L (121g/L antepartum), Hct=0.17 (0.33 antepartum). 72 hours
after the event this values were normalized. Vital signs were stabile, no further
hemorrhage occured, and woman was discharged at the forth post delivery day.
Conclusion: Early recognition and prompt treatment are important to save life of the
woman. Prompt recognition of uterine inversion, its immediate manual reposition
under general anaesthesia and transfusion of blood products are crucial for
successful tretment. Delay in recognition and treatment can result in haemorrhagic
and neurogenic shock, leading to death of a women.
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