Inversio uteri is a form of uterine prolapse that can occur during childbirth and is considered a dangerous complication in obstetrics. In this case, the uterus bulges completely or incompletely into or out of the vagina. The procedure is performed under general anesthesia and is equivalent to repositioning the uterus.
What is an inversio uteri?
Uterine prolapse is the name given to various prolapses of the uterus that push the organ out through the birth canal, in some cases to the point of exit. The vagina often bulges out with uterine prolapse, resulting in combined vaginal prolapse. Uterine prolapse is due to failure of the ligamentous apparatus that holds it in place. Uterine prolapse during childbirth is the inversio-uteri phenomenon. In this prolapse, as is characteristic of uterine prolapse, the uterus bulges into the vagina. Inversio uteri is among the sometimes most dangerous emergencies in obstetrics and is understood as a complication during childbirth. Inversion de uterus is reported to have a frequency of between one case in 20,000. Thus, the phenomenon is relatively common. The prolapse is classified according to its severity in a group between grade one and grade four. Grade four corresponds to complete inversion. In grade three, the fundus is already in the vagina. In grade two, on the other hand, it is at the same level as the internal ostium, and grade one is present when the fundus pushes into the cavum uteri.
Causes
The cause of inversio uteri is usually due to errors on the part of the obstetrician. For example, inappropriately strong traction on the umbilical cord may cause the phenomenon while the uterus is not contracting. An equally conceivable cause is increased fundal pressure. High fundal pressure may favor inversio uteri, especially in combination with abdominal compression. Many factors play an additional favoring role. These include, above all, constitutional factors such as an underdeveloped anlage of the uterus. Merely weak ligaments or structures of the uterine connective tissue may also favor the phenomenon. Affected women are also often leptosomic. The cause plays an extremely minor role in the treatment of the phenomenon. However, women with hypoplastic uteri, leptosome women, and those with weak connective tissue should be educated about their general predisposition to uterine prolapse.
Symptoms, complaints, and signs
Inversio uteri, like any other uterine prolapse, is extremely painful for the patient. Complete uterine inversion is obvious at first glance. The incomplete forms are more difficult to recognize because in this case the uterus pushes into the vaginal area as a diffuse bloody mass. Because uterine prolapse is usually associated with high blood loss, hypovolemic shock often develops quickly from an inversion uteri. This is a so-called volume-deficiency shock that occurs when there is a severe decrease in circulating blood. The first stage of this shock condition is characterized by cool and pale skin. In the second stage, this symptom is associated with tachycardia and systolic blood pressure below 100 mmHg, with collapse of the neck veins when lying down and patients complaining of thirst. In the third stage, blood pressure falls below 60 mmHg, the pulse is barely palpable, and breathing is shallow and rapid. In addition, disturbances of consciousness occur.
Diagnosis and course of the disease
Diagnosis of inversio uteri is all the more difficult when an incomplete form of the phenomenon is present. Obstetricians and physicians usually recognize incomplete uterine prolapse based only on experience and diagnose uterine prolapse by eye. The prognosis depends greatly on the length of time that elapses between the prolapse and the diagnosis. The later inversio uteri is detected, the more likely it is to cause serious complications.
Complications
Inversio uteri is a very dangerous condition that can occur during childbirth. It usually results in significant complications for both the baby and the mother, which can limit the lives of both of them. As a rule, the mother experiences extremely severe pain. These can be limited with the help of painkillers. Similarly, inversion uteri is associated with very severe blood loss, so the patient may also lose consciousness. This can lead to the development of a state of shock.Likewise, the blood pressure may drop to such an extent that the mother’s pulse can no longer be felt. As a rule, disorders of consciousness also occur. If the inversion of the uterus is not treated in time, the mother may die in the worst case. Inversio uteri is treated by surgical intervention and is performed immediately after diagnosis. In this process, most of the symptoms can be limited so that there is no longer any danger to the child or to the mother.
When should you go to the doctor?
Pregnant women who suddenly experience severe pain in the abdomen should immediately call emergency services or go to the nearest hospital. Other warning signs, such as a high rate of blood loss, cramping or signs of shock, should be clarified immediately. Inversio uteri is a medical emergency that can be fatal to both mother and child if left untreated. Therefore, those affected should seek medical attention immediately. If impaired consciousness or even hypovolemic shock develops, first aid measures must be taken. The affected woman must then be treated in a hospital. After the initial treatment, further examinations are necessary to ensure the health of mother and child. Women with weak connective tissue, hypoplastic uteri or a general predisposition to uterine prolapse are particularly susceptible to inversio uteri. They should watch carefully for unusual symptoms, especially in the last months of pregnancy, and should also consult closely with their gynecologist. The gynecologist or a general practitioner must be consulted at the first sign of prolapse.
Treatment and therapy
To treat a prolapsed uterus, patients must be placed under anesthesia as soon as possible to minimize pain and begin repositioning the uterus. As part of this repositioning, doctors first detach the placenta. After this step, the everted uterus must be compressed by hand. Only after compression, the uterus is pushed back into its original position. In the process, the organ must overcome the cervical cord ring in particular. Overcoming this barrier may be more or less difficult. If vaginal repositioning fails at the strangle ring, a laparotomy is performed. During this procedure, the uterus is pushed into its anatomically normal position. The smooth muscles of the uterus are not allowed to contract during repositioning. Contractions of the uterus are relieved by administration of medications such as nitroglycerin, metasympathomimetics, magnesium, or inhalational anesthetics. Once reduction is complete, muscle toning can be achieved by the administration of sulprostone. At the first signs of hypovolemic shock, the patient must also be provided with volume substitution. This volume substitution takes place with isotonic crystalline saline. If there has already been a large loss of blood, red cell concentrates or fresh plasma must also be given. To prevent further complications of shock, correction of metabolic acidosis, prophylaxis against shock kidneys, and therapies for ARDS or DIC also take place.
Outlook and prognosis
The prognosis of inversio uteri is favorable in most patients. The condition occurs exclusively in women during childbirth. It is a complication that, in severe cases, leads to impairment in the newborn as well as the mother. If the birth takes place without adequate medical care by doctors, midwives or a nursing team, the prognosis worsens significantly. Numerous complaints such as pain, high blood loss and cramps occur. In addition, severe trauma may develop in both mother and child. There is a likelihood of premature maternal death. The prognosis is improved as soon as the birth takes place under the supervision of a trained and experienced obstetrician. If the diagnosis is made early, there are several treatment options available. Intensive medical care becomes necessary. The goal is to avoid a state of shock in time. In most cases, surgical intervention is necessary to relieve the symptoms and ensure the survival of both mother and child. In addition, the administration of medication is common.If the high blood loss can be stopped in time and the surgical procedure proceeds without further complications, recovery gradually sets in. Nevertheless, many women complain of long-term impairments in the abdomen.
Prevention
Inversio uteri can be prevented with the same measures that are considered general preventive measures against uterine prolapse. Chief among these measures is regular pelvic floor exercises, which reduce general tissue weaknesses in the pelvic floor area.
Aftercare
As a rule, no special aftercare options are available to those affected by inversio uteri. First and foremost, a physician must be contacted in a timely manner to prevent further worsening of symptoms and to prevent further complications from this condition. Early diagnosis with subsequent treatment always has a very positive effect on the further course of the disease and can also prevent further complications. In most cases of inversio uteri, surgical intervention is necessary to alleviate these symptoms. After such an operation, the patient should rest in any case and also take care of his body. In this regard, efforts or other physical and stressful activities should be refrained from in order not to put unnecessary strain on the body. It is also necessary to take various medications. It is important to pay attention to the correct dosage and to take the medication regularly in order to alleviate the symptoms of Inversio uteri. In case of any ambiguity or questions, a doctor should be consulted. As a rule, the disease does not reduce the life expectancy of the affected person.
What you can do yourself
In any case, inversio uteri requires intensive medical care. Women who notice signs of a prolapsed uterus should alert emergency medical services immediately and then get into a lying position. Calm breathing and gentle massage can relieve the sometimes very severe pain until medical help arrives. If there has already been a large loss of blood, a longer stay in hospital is then indicated. The patient should take it easy during this time and follow the instructions of the doctor in charge. After hospitalization, the affected person must continue to take it easy until the pain has completely subsided. In the case of typical after-effects such as cramps or bleeding, it is best to talk to the gynecologist, who can prescribe a suitable medication. The discomfort can be relieved, for example, by breathing exercises, massages and natural painkillers. Proven remedies from natural medicine are arnica and devil’s claw. Mild sedatives such as St. John’s wort can also be taken after consultation with the doctor to relieve the pain and reduce any cramps. To prevent recurrence of inversio uteri, regular pelvic floor exercises should be performed concomitantly. In addition, close monitoring by the gynecologist is indicated after treatment.
