Uterine inversion during caesarean section: a case report

The present report aim to sensitise the obstetrician regarding risk of uterine inversion in a scarred uterus and the importance of immediate manual replacement. Represented case is of 40 years gravida five with previous one spontaneous abortion and previous history of three ectopic pregnancies with history of open left salpingectomy for ruptured left tubal ectopic pregnancy and history of laparoscopic right tubal clipping and uterine rupture repair for cornual pregnancy underwent an emergency caesarean section at 34 weeks. Since there were no signs of placental separation, controlled cord traction of placenta was attempted and uterine inversion was noticed. Manual replacement of uterus was done followed by manual removal of the adherent placenta. There was no postpartum haemorrhage. Inversion of uterus during caesarean section is a rare obstetric complication. If unrecognized it could lead to serious morbidity due to haemorrhage and shock. Prompt diagnosis and repositioning of the uterus are important measures in management.

Obstetric procedures

Human childbirth is a natural process but it is not always smooth and successful. Hence, several important obstetric surgical procedures and instruments were invented to assist difficult childbirth, such as caesarean section, forceps and vacuum vaginal delivery, external cephalic version, and vaginal breech delivery. The indications, the procedures, and the complications of these commonly practised obstetric surgeries are reviewed in this chapter. Other commonly performed procedures for normal labour such as episiotomy, repair of perineal tear, routine controlled cord traction for the delivery of the placenta in the third stage of labour, and manual removal of retained placenta will also be discussed.

Prevenção e tratamento da hemorragia pós-parto

ABSTRACTObjective: to identify the evidence on the prevention and treatment of postpartum haemorrhage in health care. Method: this is a descriptive and quantitative bibliographical study of the type integrative, with temporal delimitation from 2007 to 2017, with a search in the databases LILACS, MEDLINE and SciELO Virtual Library, and the results are presented in figure, analyzed by the technique of Content Analysis in the Thematic Analysis modality. Results: totaling 100 articles, which, after refinement, totaled 11 eligible for discussion with the literature. Conclusion: the correct management of the third stage of labor with the prophylaxis of postpartum haemorrhage was fundamental, based on the use of uterotonic drugs, controlled cord traction and uterine massage in place of clamping of the cord. Descriptors: Pregnant women; Pregnancy; Bleeding; Maternal Mortality; Puerperal infection; Women's Health.RESUMOObjetivo: identificar as evidências sobre a prevenção e o tratamento da hemorragia pós-parto em cuidados no campo da saúde. Método: trata-se de um estudo bibliográfico, descritivo e quantitativo, do tipo revisão integrativa, com delimitação temporal de 2007 a 2017, com busca nas bases de dados LILACS, MEDLINE e Biblioteca Virtual SciELO, e os resultados se apresentam em figura, analisados pela técnica de Análise de Conteúdo na modalidade Análise Temática. Resultados: totalizaram-se 100 artigos que, após refinamento, totalizaram 11 elegíveis para discussão com a literatura. Conclusão: evidenciou-se que é fundamental o manejo correto no terceiro estágio do trabalho de parto, com a profilaxia da hemorragia pós-parto, tendo como base o uso de drogas uterotônicas, a tração controlada de cordão e a massagem uterina em substituição ao clampeamento do cordão. Descritores: Gestantes; Gravidez; Hemorragia; Mortalidade Materna; Infecção Puerperal; Saúde da Mulher.RESUMENObjetivo: identificar las evidencias sobre la prevención y el tratamiento de la hemorragia posparto en cuidados en el campo de la salud. Método: se trata de un estudio bibliográfico, descriptivo y cuantitativo, del tipo revisión integrativa, con delimitación temporal de 2007 a 2017, con búsqueda en las bases de datos LILACS, MEDLINE y Biblioteca Virtual SciELO, y los resultados se presentan en figura, analizados por la técnica de Análisis de Contenido en la modalidad Análisis Temático. Resultados: se totalizaron 100 artículos que, después de refinamiento, totalizaron 11 elegibles para discusión con la literatura. Conclusión: se evidenció que es fundamental el manejo correcto en la tercera etapa del trabajo de parto, con la profilaxis de la hemorragia posparto, teniendo como base el uso de drogas uterotónicas, la tracción controlada de cordón y el masaje uterino en sustitución al clampeamiento del cordón. Descriptores: Mujeres Embarazzadas; Embarazzo; Hemorrragia; Infección Puerperal; Salud de la Mujer.

Novel use of balloon tamponade saves a patient with uterine inversion in severe shock

A patient with G1P0 status 38 weeks pregnancy with pain with no high risk delivered at PHC, Hatod, Madhya Pradesh (India). She delivered a male baby by spontaneous vaginal delivery of 3.1 kg. All of sudden after 2nd stage of labour, her 3rd stage of labour was eventful. Placenta did not come out spontaneously so controlled cord traction was given by the ANM over the PHC. She was given intramuscular oxytocin 5 IU. She did the traction with proper care but inspite of that while doing so placenta got separated but there was complete uterine inversion. ANM herself tried to reposit the uterus but could not do so. So ANM immediately referred her from PHC to MYH, Indore, Madhya Pradesh (India).

Active management of third stage of labour with special reference to misoprostol

Active management of third stage of labour is an effective method of preventing postpartum hemorrhage. It includes administration of uterotonic immediately after delivery of the baby, delaying cord clamping for at least 1-3 minutes to reduce rates of infant anaemia, performing controlled cord traction for removing the placenta and postpartum vigilance, ie, assess the uterine tone to ensure a contracted uterus; and continue to check every 15 minutes for 2 hours. If there is uterine atony, fundal massage should be performed and patient should be monitored more frequently. Though oxytocin is the best drug for routine prophylaxis, misoprostol is a relatively newer drug which is now included in the various guidelines for prevention and treatment of postpartum hemorrhage. It can be used as an effective and safe drug in areas with poor access to skilled healthcare providers and facilities.