Inversio uteri is a form of uterine prolapse that can occur during childbirth and is considered a dangerous complication in obstetrics. The uterus invaginates completely or incompletely into the vagina or out of the vagina. The treatment is carried out under general anesthesia and corresponds to a repositioning of the uterus.
What is an inversion of the uterus?
Like any other uterine prolapse, inversio uteri is extremely painful for the patient. Complete uterine inversion can be seen at first glance.
Various prolapses of the uterus are known as uterine prolapse, which push the organ outwards through the birth canal in some cases up to the exit. The vagina often bulges out during a prolapsed uterus, resulting in a combined vaginal prolapse. Uterine prolapse is based on the failure of the supporting ligaments. A prolapsed uterus during childbirth is the inversio uteri phenomenon. See wholevehicles for What are the Meanings of Heart Disease.
In this prolapse, the uterus invaginates into the vagina, as is characteristic of uterine prolapse. Inversio uteri is one of the most dangerous emergencies in obstetrics and is understood as a complication during childbirth. Inversion of the uterus is reported to occur between 1 in 20,000 cases. This phenomenon is relatively common.
The incident is divided into a group between level one and level four according to its severity. Degree four corresponds to complete inversion. In the third degree, the fundus is already in the vagina. In contrast, grade two is at the same level as the internal ostium, and grade one is when the fundus presses into the uterine cavity.
Causes
The cause of an inversio uteri is usually to be found in errors on the part of the obstetrician. For example, an inappropriately strong pull on the umbilical cord can cause the phenomenon as long as the uterus does not contract. Another conceivable cause is increased pressure in the fundus. A high fundus pressure can favor an inversio uteri, especially in combination with abdominal pressure.
Many factors play an additional favorable role. These include, above all, constitutional factors such as an underdeveloped structure of the uterus. Even weak ligaments or structures of the uterine connective tissue can favor the phenomenon. The affected women are also often leptosome. The cause plays only 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 apprised of their general predisposition to uterine prolapse.
Symptoms, Ailments & Signs
Like any other uterine prolapse, inversio uteri is extremely painful for the patient. Complete uterine inversion can be seen at first glance. The incomplete forms are more difficult to recognize because the uterus pushes itself into the vaginal area as a diffusely bloody mass. Since the uterine prolapse is usually associated with high blood loss, an inversio uteri often quickly turns into hypovolemic shock.
This is a so-called volume deficiency shock, which occurs when there is a severe reduction in the circulating blood. The first stage of this state of shock 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 & course of disease
The diagnosis of an inversio uteri is all the more difficult if an incomplete form of the phenomenon is present. Obstetricians and doctors usually recognize incomplete uterine prolapses only on the basis of experience and diagnose the uterine prolapse visually. Prognosis is highly dependent on the length of time that elapses between the incident and diagnosis. The later an inversio uteri is recognized, the more likely it is to cause serious complications.
Complications
Inversio uteri is a very dangerous condition that can occur during childbirth. As a rule, this leads to considerable complications for the child and the mother, which can limit the lives of both of them. The mother usually experiences extremely severe pain. These can be reduced with the help of painkillers.
Likewise, the inversio uteri is associated with a very strong loss of blood, so that the patient can also lose consciousness. This can lead to the development of a state of shock. The blood pressure can also drop so much that the mother’s pulse can no longer be felt. Disturbances of consciousness usually also occur.
If the inversio uteri is not treated in time, it can lead to the death of the mother in the worst case. The treatment of the inversio uteri is carried out by means of a surgical intervention and is carried out immediately after the diagnosis. Most complaints can be limited so that there is no longer any danger to the child or the mother.
When should you go to the doctor?
Pregnant women who suddenly experience severe abdominal pain should call an ambulance or go to the nearest hospital immediately. Other warning signs such as high blood loss, cramps or signs of shock must be clarified immediately. Inversion of the uterus is a medical emergency that, if left untreated, can be fatal to both mother and child. Therefore, those affected should consult a doctor immediately. If impaired consciousness or even hypovolemic shock occurs, first aid measures must be provided.
The affected woman then had to 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 prone to inversio uteri. You should pay close attention to unusual symptoms, especially in the final months of pregnancy, and also consult your gynaecologist closely. At the first sign of an incident, the gynecologist or a general practitioner must be consulted.
Treatment & Therapy
To treat a prolapsed uterus, patients must be placed under anesthesia as quickly 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 is the uterus pushed back to its original position. The organ has to overcome the cervical node in particular. Overcoming this barrier can be more or less difficult. If vaginal repositioning at the cinching ring fails, a laparotomy is performed. During this procedure, the uterus is pushed into its anatomically normal position. The smooth muscle of the uterus must not contract during repositioning.
Uterine contractions are relieved by the administration of drugs such as nitroglycerin, metasympathomimetics, magnesium, or inhalational anesthetics. As soon as the reduction is complete, the muscles can be toned by administering Sulproston. At the first sign of hypovolemic shock, the patient must also be treated with volume replacement.
This volume substitution takes place with isotonic crystalline saline. If a large amount of blood loss has already taken place, erythrocyte concentrates or fresh plasma must also be given. In order to prevent further complications of the shock, corrections of the metabolic acidosis, prophylaxis against shock kidneys and therapies for ARDS or DIC also take place.
Outlook & Forecast
The prognosis of inversio uteri is favorable for most patients. The disease occurs only in women during childbirth. It is a complication that, in severe cases, causes harm to both the newborn and the mother. If the birth takes place without adequate medical care from 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 can develop in both mother and child. The likelihood of the mother dying prematurely is given.
The prognosis is improved once delivery takes place under the supervision of a trained and experienced obstetrician. If the diagnosis is made early, there are a number of treatment options available. Intensive medical care is required. The aim is to avoid shock in good time. In most cases, a surgical intervention is necessary, which leads to an alleviation of the symptoms and ensures the survival of both mother and child. In addition, the administration of medication is common.
If the high blood loss can be staunched in time and the surgical procedure proceeds without further complications, recovery will gradually set in. However, many women complain of long-term impairments in their abdomen.
Prevention
An inversio uteri can be prevented with the same measures that are considered general preventive measures against uterine prolapse. These measures include, above all, regular pelvic floor exercises, which reduce general tissue weaknesses in the area of the pelvic floor.
Aftercare
As a rule, those affected by inversio uteri do not have any special options for aftercare. First and foremost, a doctor must be contacted in good time so that the symptoms do not worsen and there are no further complications of this disease. 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, an operation is necessary to alleviate these symptoms. After such an operation, the person concerned should definitely rest and take care of his body. Exertion or other physical and stressful activities should be avoided in order not to unnecessarily burden the body.
It is also necessary to take various medications. It is always important to ensure the correct dosage and also to take the medication regularly in order to alleviate the symptoms of inversio uteri. If anything is unclear or you have any questions, you should consult a doctor. As a rule, the disease does not reduce the life expectancy of the person affected.
You can do that yourself
An inversio uteri must always be treated in intensive care. Women who notice signs of a prolapsed uterus should call 911 immediately and then lie down. Calm breathing and gentle massages can relieve the sometimes very severe pain until medical help arrives.
If a large amount of blood loss has already occurred, a longer hospital stay is then indicated. The patient should rest during this time and follow the instructions of the responsible doctor. After hospitalization, the affected person must continue to rest until the pain has completely subsided. In the case of typical after-effects such as cramps or bleeding, it is best to talk to your gynaecologist, who can prescribe a suitable medication.
The symptoms can be relieved, for example, with breathing exercises, massages and natural painkillers. Proven remedies from naturopathy are arnica and devil’s claw. Light sedatives such as St. John’s wort can also be taken after consultation with the doctor to relieve the pain and reduce any cramps. In order to prevent a renewed inversio uteri, pelvic floor exercises should be carried out regularly. In addition, close monitoring by the gynecologist is indicated after the treatment.