Chambrier C, Zayneh E, Pouyau A, Pacome J P, Boulétreau P
Département d'Anesthésie-Réanimation, Hôtel-Dieu, Lyon.
Ann Fr Anesth Reanim. 1991;10(1):81-3. doi: 10.1016/S0750-7658(05)80275-8.
A case of complete uterine inversion, in a 27-year-old woman after delivery of her third child, is reported. Because of lack of placental separation after 40 min. manual removal was carried out under general anaesthesia (midazolam, ketamine, alfentanil). The placenta was quickly and easily removed, but followed immediately by protrusion of the uterine fundus at the vulva. Simultaneous, blood pressure became unmeasurable, and the patient became cyanosed. The uterus remained impossible to replace until anaesthesia had been deepened. The patient remained shocked despite intravenous fluids and catecholamines. As soon as the uterus was replaced, blood pressure rose to 80 mmHg. The patient was extubated 50 minutes later, blood pressure being 105/80 mmHg. Acute and subacute puerperal uterine inversion is a rare obstetrical emergency (1 in 20,000 deliveries) with a 15% mortality rate. Immediate recognition and early treatment to relax the cervico-uterine junction, should ensure rapid replacement of the uterus.
报告了一例27岁女性在第三次分娩后发生完全性子宫内翻的病例。由于40分钟后胎盘仍未分离，遂在全身麻醉（咪达唑仑、氯胺酮、阿芬太尼）下进行人工剥离。胎盘迅速且顺利地被取出，但随后子宫底立即在外阴处突出。与此同时，血压无法测量，患者出现发绀。在加深麻醉之前，子宫一直无法复位。尽管给予了静脉补液和儿茶酚胺类药物，患者仍处于休克状态。子宫一旦复位，血压升至80 mmHg。50分钟后患者拔除气管插管，血压为105/80 mmHg。急性和亚急性产褥期子宫内翻是一种罕见的产科急症（每20000例分娩中有1例），死亡率为15%。立即识别并尽早治疗以松弛宫颈-子宫交界处，应能确保子宫迅速复位。
