17 - Acute puerperal uterine inversion

Summary

Acute puerperal uterine inversion is a rare, potentially life-threatening complication of pregnancy. A dilated cervix with a relaxed uterus and simultaneous downward traction on the fundus are the possible factors leading to inversion of the uterus. The best way to manage the neurogenic component would be to reposition the uterus. The first-line procedure which is commonly used for manual replacement of uterus is referred to as Johnson's manoeuvre. Use of tocolytics in a situation where postpartum haemorrhage is a common accompaniment is fraught with danger. There are a few techniques which have been used during surgery to reduce the inverted uterus: Huntingdon's operation, Haultain's operation and hysterectomy. It is recommended to use an uterotonic drug in the initial phase of management after repositioning. Oxytocin infusion, misoprostol per rectum or prostaglandins can be used for this purpose.