Uterine inversion

Introduction to uterine inversion Uterine varus refers to the uterus at the bottom of the uterus into the uterine cavity, and even from the cervix, this is a rare and serious complication during childbirth, most of which occurs in the third stage of labor, if not treated in time, often due to shock, Bleeding causes the mother to die within 3 to 4 hours. basic knowledge The proportion of illness: the incidence rate is about 0.0002% - 0.0004% Susceptible people: women Mode of infection: non-infectious Complications: shock

Cause of uterine inversion

(1) Causes of the disease

Most of the uterus is improperly treated due to the third stage of labor (about 50%), but its prerequisites must be the relaxation of the uterine wall and the expansion of the cervix. The factors that contribute to uterine inversion are:

1. The result of the midwife's strong attachment to the placenta umbilical cord at the bottom of the uterus. At this time, if the umbilical cord is tough and does not break from the placenta, uterine varus will occur when the uterus is squeezed.

2. The umbilical cord is too short or entangled: excessive pulling of the umbilical cord during the delivery of the fetus can also cause uterine inversion.

3. Congenital uterine dysplasia or maternal excessive debilitation, in the labor process due to cough or the second stage of labor forceful breath, abdominal pressure increased, it will also cause uterus varus.

4. Maternal standing delivery: due to the fetal weight on the placenta umbilical cord traction caused by uterine inversion.

5. The use of magnesium sulfate to relax the uterus during pregnancy-induced hypertension also promotes uterine varus; it has been reported that the implanted placenta also promotes uterine varus.

(two) pathogenesis

1. The uterine wall is weak, weak and weak, especially the weak bottom of the uterus, the ability to resist various forces to the uterine cavity is poor, common in congenital uterine dysplasia, twin pregnancy and pathological uterine varus. Pathological uterine inversion is usually caused by direct invasion or chronic compression of various tumors at the bottom of the uterus to destroy the surrounding uterine smooth muscle. The increasing tumor produces a chronic force to the uterine cavity, the cervix and even the vagina on the muscle wall, leading to uterine varus.

2. The pressure or tension acting on the bottom of the uterus causes the bottom of the uterus to fall into the uterine cavity.

(1) Improper pressure on the bottom of the uterus is usually seen after the baby is delivered, the uterus is in a relaxed state, and the placenta has not been stripped, especially at the bottom of the palace. The midwife presses the bottom of the uterus in the direction of the vagina, causing the uterus to turn inward. This condition is also seen in the uterine contraction, uterine hemorrhage, when pressing the bottom of the palace force, leading to uterus varus.

(2) The pulling force acting on the bottom of the uterus is mainly derived from the umbilical cord. It is common in the following cases: the uterus is not contracted in the third stage of labor, the placenta is not peeled off, and the umbilical cord is pulled hard; the umbilical cord is too short or relatively short (the umbilicus around the neck or around the trunk) Or limbs, the uterus is not contracted to give birth to the fetus; standing or giving birth to the fetal gravity of the traction.

3. The weak muscle wall at the bottom of the uterus and/or the inappropriate pressure or tension at the bottom of the uterus is the mechanism to initiate the uterus varus, but after partial uterus varus, the contraction of the uterine wall and even the spasmodic contraction are aggravated and maintained leading to the uterus. The mechanism of turning over. Think of the uterus as a half-ball with good elasticity. Apply a certain pressure, the wall of the ball will sink, remove the external force, naturally bounce back, and restore the original shape; when the pressure is too large, it cannot bounce back, form a partial depression, or even flip it completely completely. The original inner surface is turned into an outer surface, and the outer surface is turned into an inner surface. After the uterus is turned, the bottom of the palace is cup-shaped, muscle spasm, limiting the natural recovery of the muscle wall. In addition, the muscle wall that is turned out reaches the uterine cavity, which is a place occupying or load or stimulation to the uterine cavity, which can stimulate the further contraction of the uterus to produce a downward force, and the muscle wall that is turned out is moved to the cervix and the vagina.

Intrauterine doubling according to the onset time can be divided into: 1 acute uterine inversion: the cervix has not tightened after the uterus is turned out, accounting for about 75%; 2 subacute uterine inversion: the cervix has tightened after the uterus is turned out, accounting for about 15% 3 chronic uterine inversion: the uterus has been retracted from the cervix for more than 4 weeks, and the uterus has been retracted in the varus position but still stays in the vagina, accounting for about 10%.

According to the degree of uterus inversion can be divided into: 1 incomplete uterus varus: the bottom of the uterus is invaginated, can be close to the cervix or over but there are still some uterine cavity; 2 complete uterine inversion: the bottom of the uterus falls outside the cervix, But still in the vagina; 3 uterine inversion: the entire inverted uterus is exposed outside the vaginal opening.

Uterine inversion prevention

Prognosis: Acute complete uterine varus, usually after the onset of the disease, the patient is immediately in a state of severe shock. If it is not discovered and rescued in time, it often dies within 3 to 4 hours of onset, the case fatality rate is 15% to 16%, and the highest mortality rate can reach 43%. Common causes of death are shock, bleeding, and infection. However, if it can be found in time, the correction of shock can be done by vaginal manipulation, and the prognosis is good.

prevention:

1. Strengthen the training of birth attendants and do a good job in the third stage of labor, which is an important measure to prevent uterine varus.

2. Do not force the bottom of the uterus or pull the umbilical cord after the baby is delivered. When performing artificial peeling of the placenta, avoid moving the uterine wall.

Uterine inversion complications Complications

The main comorbidities of the disease include severe pain, bleeding, infection and shock.

Symptoms of uterus varus Common symptoms Vaginal bleeding under the abdomen swells painful abdominal pain shock postpartum lower abdominal pain or...

Symptom

(1) history and labor management: previous uterine inversion history, combined with uterine dysplasia such as uterine malformation, twin pregnancy, polyhydramnios, urgency, standing production, umbilical cord is too short or relatively short, squeeze the bottom of the palace Or pull the umbilical cord to assist in the delivery of the placenta, etc., master the above clinical data to help diagnose uterine varus.

(2) Pain performance: the degree of pain varies, the light can only be expressed as postpartum lower abdominal pain or vaginal swelling, severe cases can cause painful shock, typical uterine inversion pain is the third stage of labor, pulling Severe lower abdominal pain suddenly appeared after the umbilical cord or pressing the fundus. Note that this pain is persistent in order to distinguish it from uterine contraction pain.

(3) Bleeding performance: The characteristics of bleeding after uterus varus are different. Patients with chronic uterine varus only show irregular vaginal bleeding or menorrhagia; acute uterine bleeding is related to placental stripping, and the placenta is not peeled off. No bleeding, partial exfoliation of the placenta and complete removal of the placenta can manifest as major bleeding.

(4) Infection manifestations: Infections are common in chronic uterine varus or acute uterine inversion. After various methods of reduction, they can be manifested as local infection of the reproductive system, and can also be manifested as pelvic peritoneal peritonitis or even sepsis.

(5) shock: uterine varus can cause shock, the cause and mechanism of shock are different because of the clinical manifestations of uterus varus, acute uterine inversion pain, can quickly appear painful shock after uterine inversion, relative to occur Earlier, vaginal bleeding does not match the degree of shock; acute uterine inversion combined with postpartum hemorrhage, if not timely control of bleeding, correction of anemia and improvement of microcirculation, can be complicated by hemorrhagic shock; while pain and blood loss can interact, leading to increased shock, chronic Inflammatory shock can occur due to chronic blood loss and exudation, combined with various serious infections.

(6) Local compression performance: In addition to the feeling of lower abdomen, patients may have difficulty in defecation and urination.

2. Signs

(1) Abdominal examination: Acute uterine inversion of the abdomen usually does not touch the regular uterus contour, the uterus is significantly lower, widened, and the bottom of the uterus is cup-shaped or stepped; chronic uterine inversion can only be manifested as signs of peritonitis.

(2) vaginal examination: acute uterine vaginal bleeding is not the same; placenta may be stripped or may not be stripped, placenta is not easy to be diagnosed; placenta stripper can touch or see soft ball stuffed with birth canal or out of the vagina Mouth, carefully check the ball on the circumference of the cervix or find the fallopian tube opening can be clearly diagnosed, chronic uterine inversion in addition to the performance of acute uterine inversion, as well as chronic inflammation, inflammatory vaginal discharge, tumor surface ulcer, bleeding , gorgeous and so on.

Uterine inversion

Imaging techniques such as B-ultrasound are useful for identifying uterine inversion.

Diagnosis of uterine inversion

Diagnosis of uterine inversion can be made based on medical history and examination.

Intrauterine doubling should be differentiated from uterine submucosal fibroids and postpartum uterine prolapse.

1. Uterine submucous myoma: the development of uterine fibroids to the uterine mucosa, protruding in the uterine cavity, such as submucosal fibroids pedicle, uterine contraction can be discharged from the cervix and suspended in the vagina, gynecological examination, There is a uniform enlarged uterus in the pelvic cavity. If the fibroid reaches the cervix, the cervix is loose. The finger enters the cervical canal to reach the tumor. If the cervix is discharged, the fibroid can be seen. The surface is a dark red mucous membrane. Coat, sometimes with ulcers and secondary infections, such as the use of uterine probes from the tumor can be explored into the uterine cavity, the length of which matches the size of the examined uterus, but it should be noted that when the larger fibroids are combined, some of the uterine wall can be merged. Acute uterine inversion is often during childbirth. Patients have vaginal bleeding and shock performance, and there is no difficulty in identification.

2. Uterine prolapse: The patient is generally in good condition. The gynecological examination shows that there is a cervix under the mass. When the breath is down, the uterine prolapse is more obvious. When the pelvic examination is performed, the uterus can be touched.

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