Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda.
BMC Womens Health. 2020 Oct 2;20(1):220. doi: 10.1186/s12905-020-01089-0.
Subacute uterine inversion is a very rare complication of mid-trimester termination of pregnancy that should be considered in a situation where unsafe abortion occurs.
We present a case of subacute uterine inversion complicated by hypovolemic shock following an unsafe abortion in a 17-year-old nulliparous unmarried girl. She presented with a history of collapse, mass protruding per vagina that followed Valsalva, and persistent lower abdominal pain but not vaginal bleeding. This followed her second attempt to secretly induce an abortion at 18 weeks amenorrhea. On examination, she was agitated, severely pale, cold on palpation, with an axillary temperature of 35.8 °C, a tachycardia of 143 beats per minute and unrecordable low blood pressure. The abdomen was soft and non-tender with no palpable masses; the uterine fundus was absent at its expected periumbilical position and cupping was felt instead. A fleshy mass with gangrenous patches protruding in the introitus was palpated with no cervical lip felt around it. We made a clinical diagnosis of subacute uterine inversion complicated with hypovolemic shock and initiated urgent resuscitation with crystalloid and blood transfusion. Non-operative reversal of the inversion failed. Surgery was done to correct the inversion followed by total abdominal hysterectomy due to uterine gangrene.
Our case highlights an unusual presentation of subacute uterine inversion following unsafe abortion. This case was managed successfully but resulted in significant and permanent morbidity.
中期妊娠终止后发生亚急性子宫内翻是一种非常罕见的并发症，应在不安全流产的情况下考虑。
我们报告了一例 17 岁未婚未产妇因不安全流产导致亚急性子宫内翻并发失血性休克的病例。她有晕厥病史，阴道内有肿块突出，可随瓦氏动作移动，持续性下腹痛但无阴道出血。这是她第二次试图秘密在 18 周闭经时进行流产。检查时，患者烦躁不安，面色苍白，摸起来发冷，腋温 35.8°C，心动过速 143 次/分，血压无法测出。腹部柔软，无压痛，子宫底位于脐周预期位置以下，感觉到杯状凹陷。阴道入口处可触及突出的带坏疽斑块的肉质肿块，周围未触及宫颈唇。我们临床诊断为亚急性子宫内翻并发失血性休克，并立即开始用晶体液和输血进行紧急复苏。非手术复位内翻失败。由于子宫坏疽，进行了手术以纠正内翻，并随后进行了全子宫切除术。
我们的病例突出了不安全流产后亚急性子宫内翻的不常见表现。该病例得到成功治疗，但导致了严重和永久性的发病率。
