RESUMO
Acute puerperal inversion is both rare and serious (1/20000 deliveries in France) and may lead to significant morbidity and mortality. Outcome depends on the degree of uterine bleeding and the presence or not of a state of shock. Acute puerperal inversion occurs at the time of placental delivery. Four stages are usually described by degree of exteriorization of the uterus. The diagnosis is essentially clinical. The predisposing factors are hypotonic uterus, fundal implantation of the placenta and placental acretas. 60% of all cases are caused by precipitous manoeuvres including traction on the cord or improper fundal pressure. Once a diagnosis is made immediate measures must be undertaken to assure clinical stability of the mother. Manuel reinversion of the uterus must be done quickly to avoid a cervical stricture that may form within thirty minutes of the inversion making successful manipulation very difficult. Failure or reoccurrence requires surgical treatment either by abdominal or vaginal approach. We report on two cases: one of complete inversion leading to a hysterectomy in order to control bleeding and a second case of incomplete inversion where repositioning was successful.
Assuntos
Transtornos Puerperais/diagnóstico , Transtornos Puerperais/terapia , Inversão Uterina/diagnóstico , Inversão Uterina/terapia , Doença Aguda , Adulto , Antibacterianos/uso terapêutico , Causalidade , Feminino , França , Humanos , Histerectomia , Morbidade , Ocitócicos/uso terapêutico , Placenta Acreta/complicações , Cuidado Pós-Natal/métodos , Gravidez , Transtornos Puerperais/classificação , Transtornos Puerperais/epidemiologia , Índice de Gravidade de Doença , Tração/efeitos adversos , Resultado do Tratamento , Cordão Umbilical , Inversão Uterina/classificação , Inversão Uterina/epidemiologia , Versão Fetal/efeitos adversosAssuntos
Leiomioma/complicações , Inversão Uterina/etiologia , Neoplasias Uterinas/complicações , Adulto , Biópsia , Terapia Combinada , Dilatação , Dismenorreia/etiologia , Dispareunia/etiologia , Eletrocirurgia , Feminino , Hormônio Liberador de Gonadotropina/análogos & derivados , Humanos , Histerectomia , Laparoscopia , Leiomioma/diagnóstico , Leiomioma/terapia , Imageamento por Ressonância Magnética , Menorragia/etiologia , Inversão Uterina/classificação , Inversão Uterina/diagnóstico , Inversão Uterina/terapia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapiaRESUMO
Chronic non-puerperal uterine inversions are rare but the occasional case has to be managed without previous experience. Of the 77 cases reported, 75 (97.4%) were tumour produced and 20% of these tumours were malignant. The importance of taking biopsies from tumours before definitive surgery is highlighted. Adequate surgical management requires experience in vaginal surgery.
