Inversion of uterus

1. NAME : TALHA NOOR
CLASS : 4TH YEAR
SUBJECT: GYENCOLOGY

2. TOPIC: INVERSION OF UTERUS

3. CONTENT:
 Introduction
 Definition
 Classification
 Causes
 Sign and symptoms
 Treatment
 Prevention

4. INTRODUCTION
 This is rare but life threatening complication of the
uterus.
 It occurs in approximately 1 in 10000 deliveries.

5. DEFINITION:
 When the uterus turns inside out, It is called
“uterine inversion”.
OR
 Inversion of the uterus means uterus is turned
inside out partially or completely.

6. CLASSIFICATION
 According to the types
 According to the degrees
 According to the timing event.

7. TYPES
 Incomplete inversion:
When fundus of uterus has turned inside
out, like toe of socks, but inverted fundus has not
descended through Cervix
 Complete inversion:
When the inverted fundus has passed
completely through Cervix to lie within the
vagina or lie often outside the Vaginal Wall.

8. DEGREES
 First degree:
The uterus is partially turned out.
 Second degree:
The fundus has passed through the cervix but
not outside the vagina.
 Third degree:
The fundus is prolapsed outside the vagina.
 Fourth degree:
The uterus, cervix and vagina are completely
turned inside out and are visible.

9. DEGREES
 First Degree :
Incomplete Inversion.
 Second Degree :
Complete inversion in the vagina.
 Third Degree :
Complete inversion outside the Vagina

11. ACCORDING TO TIMING OF EVENT
 Acute :
It occurs within 24 hrs of delivery.
 Sub-acute :
It presents between 24 hrs & 4 wks of
delivery.
 Chronic :
It presents beyond 4 wks of delivery or in
non pregnant stage.

12. CAUSES
 Excessive cord traction (esp. with an unseparated
placenta)
 Excessive fundal pressure (esp. when uterus is
poorly contracted Atonic)
 Fundal implantation of placenta

13. SIGN & SYMPTOMS
 Hemorrhage (94%).
 Severe abdominal pain in 3rd stage.
 Hypotension with Bradycardia: shock out of
proportion to the blood loss (neurogenic due to
increased vagal tone).
 Lump in the vagina.
 Abdominal tenderness .
 Mass in the vagina on vaginal examination.

14. TREATMENT:
 If uterine inversion occurs, gently push
the uterus back into position. If the uterus has
contracted down in an inverted position, the patient
may be treated with nitroglycerin (50-100 micg IV)
to relax the myometrium and allow uterine
replacement.

15. PREVENTION
 Manual removal of placenta should be done
in proper manner.

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