Total Uterine inversion after normal vaginal delivery: a case report study

Puerperal uterine inversion is a rare obstetric emergency that may cause maternal mortality. We describe a multiparous women with total uterine inversion after a normal vaginal delivery.

Case Report: 

A 28 years old, gravid3 pregnant women 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 of the fetal  due to the history of placental adhesion, umbilical cord traction was avoided and after 20 minutes, 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 subtotal abdominal hysterectomy was performed. Pathological examination revealed placenta inccreta and The placenta was found completely adherent at the fundus.

Conclusion :

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 third stage of labor to manage the possibility of inversion.