Resident.
Professor, Maternal-Fetal Medicine Fellowship Director, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR.
Obstet Gynecol Surv. 2018 Jul;73(7):411-417. doi: 10.1097/OGX.0000000000000580.
Uterine inversion is frequently accompanied by postpartum hemorrhage and hypovolemic shock. Morbidity and mortality occur in as many as 41% of cases. Prompt recognition and management are of utmost importance.
The aim of this review is to describe risk factors, clinical and radiographic diagnostic criteria, and management of this rare but potentially life-threatening complication of pregnancy.
A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched.
There were 86 articles identified, with 25 being the basis of review. Multiple risk factors for a uterine inversion have been suggested including a morbidly adherent placenta, short umbilical cord, congenital weakness of the uterine wall or cervix, weakening of the uterine wall at the placental implantation site, fundal implantation of the placenta, uterine tumors, uterine atony, sudden uterine emptying, fetal macrosomia, manual removal of the placenta, inappropriate fundal pressure, excessive cord traction, and the use of uterotonic agents prior to placental removal. The diagnosis is almost exclusively clinical, and successful treatment depends on prompt recognition of the uterine inversion. Treatment options include manual and surgical replacement of the inverted uterus. There is no consensus regarding mode of delivery in subsequent pregnancies as reinversion in a subsequent pregnancy is unpredictable. However, if surgical replacement was required in the index pregnancy and involved an incision into the contractile portion of the uterus, cesarean delivery is a reasonable management option similar to that offered for a prior classic cesarean section.
Successful treatment is dependent on prompt recognition. Management should include resuscitation of maternal hypovolemic shock, as well as repositioning of the inverted uterine fundus.
Uterine inversion is a rare but potentially life-threatening obstetrical emergency.
子宫内翻常伴有产后出血和低血容量性休克。多达 41%的病例发生发病率和死亡率。及时识别和处理至关重要。
本综述旨在描述这种罕见但潜在危及生命的妊娠并发症的危险因素、临床和放射学诊断标准以及处理方法。
对 PubMed、Web of Science 和 CINAHL 进行了无年限限制的搜索。
共确定了 86 篇文章，其中 25 篇作为综述的基础。子宫内翻的多个危险因素包括胎盘粘连、脐带过短、子宫壁或宫颈先天薄弱、胎盘植入部位子宫壁减弱、胎盘底位植入、子宫肿瘤、子宫收缩乏力、子宫突然排空、胎儿巨大、胎盘人工剥离、不当的宫底压力、脐带过度牵引以及胎盘剥离前使用子宫收缩剂。诊断几乎完全是临床的，成功的治疗取决于子宫内翻的及时识别。治疗选择包括手动和手术替换倒置的子宫。对于后续妊娠的分娩方式没有共识，因为后续妊娠的再内翻是不可预测的。然而，如果在指数妊娠中需要手术替换，并且涉及到子宫收缩部分的切口，则剖宫产是一种合理的管理选择，类似于为先前的经典剖宫产提供的选择。
成功的治疗取决于及时识别。管理应包括产妇低血容量性休克的复苏，以及倒置子宫底的重新定位。
子宫内翻是一种罕见但潜在危及生命的产科急症。
