Total Uterine Inversion After Normal Vaginal Delivery: A Case Report

Ladan Kashani; Afsaneh Tehranian; Shima Mohiti; Ladan Hosseini

doi:10.18502/crcp.v6i3.7126

Ladan Kashani Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
Afsaneh Tehranian Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
Shima Mohiti Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
Ladan Hosseini Research Development Center, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/crcp.v6i3.7126

Keywords: Total uterine inversion; Normal vaginal delivery; Case report

Abstract

Puerperal uterine inversion is a rare obstetric emergency that may cause maternal mortality. We describe a multiparous woman with total uterine inversion after a normal vaginal delivery. A 28-years-old, gravid 3, pregnant woman was admitted to the hospital in the first stage of labor. She had a past medical history of curettage due to abnormal vaginal bleeding following her second vaginal delivery and the present pregnancy proceeded without complications. After the delivery, due to the history of placental adhesion, umbilical cord traction was avoided and after 20 min, the patient was asked to push hard. During a Valsalva maneuver, the uterus and the placenta were suddenly expelled from the vagina. The placenta was completely adherent to the decidua and the patient displayed no signs of shock. Then manual repositioning of the uterus was performed by a closed fist and a subtotal abdominal hysterectomy was performed. Pathological examination revealed placenta accreta and the placenta was found completely adherent at the fundus. Uterine inversion usually occurs unexpectedly and is unpreventable in some cases. Assessment of the possible risk factors before delivery may help predict its occurrence. Therefore, in women with a positive history, special measures should be taken in the third stage of labor to manage the possibility of inversion.