What is uterine inversion
Synonym: uterine inversion
Under one Inversio uteri or Uterine inversion one understands the eversion of the womb (uterus) into the vagina (vagina). It is one of the obstetric emergencies.
ICD10 code: N85.5
Uterine inversion occurs with a frequency of about one case in 5,000 to 20,000 births.
Inversio uteri is caused by excessive tension on the umbilical cord when the uterus is not contracted or by increased fundus pressure in connection with the abdominal press. The disease is favored by constitutional factors such as uterine hypoplasia or weakly developed ligaments or connective tissue structures on the uterus. Leptosome women are more likely to be affected.
According to the extent of the inversion one differentiates:
4.1 Grade 1
Uterine depression. The fundus pushes into the cavum uteri like a dent
4.2 Grade 2
Inversio uteri incompleta. The fundus is at the level of the internal ostium.
4.3 Grade 3
Inversio uteri completa. Fundus lies in the vagina.
4.4 Grade 4
Inversio uteri prolapse. Complete inversion.
5 point in time
- Acute: within 24 hours post partum
- Subacute: More than 24 hours post partum
- Chronic: More than a month post partum
An inversio uteri is extremely painful for the patient and, in combination with the resulting blood loss, can quickly lead to hypovolemic shock. Complete uterine inversion is difficult to miss, while incomplete uterine inversion only shows a diffuse bloody mass in the vagina.
The prolonged uterus is repositioned as quickly as possible under anesthesia. The placenta is first loosened, and then the everted uterus is manually compressed and pushed back. Overcoming the cervical constriction ring is usually the most difficult. If vaginal reduction is unsuccessful, the uterus is returned to its normal position via a laparotomy.
For reduction, the smooth muscles of the uterus are relaxed with beta sympathomimetics, nitroglycerin, inhalation anesthetics or magnesium. After the reduction has been successfully completed, it is toned with sulprostone (Nalador®).
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