Kumari Sarita, Singh Vinita, Ray Alokananda, Swain Amlan
Department of Obstetrics and Gynaecology, Tata Main Hospital, Jamshedpur, Jharkhand, India.
Department of Anaesthesiology, Tata Main Hospital, Jamshedpur, Jharkhand, India.
J Family Med Prim Care. 2022 Feb;11(2):793-795. doi: 10.4103/jfmpc.jfmpc_1164_21. Epub 2022 Feb 16.
Acute uterine inversion is a rare life-threatening complication of third stage of labour. In majority of cases, exact aetiology is unknown. It should be strongly suspected when the triad of haemorrhage, shock and severe abdominal pain with bearing down sensation is present after delivery of placenta. It can occur even after active management of third stage of labour. Diagnosis is essentially clinical. Expeditious manual repositioning of uterus and simultaneous liberal use of uterotonics is the management of choice. This was successfully attempted in the present case where a 26-year-old multiparous woman, without any identifiable risk factors, developed acute puerperal uterine inversion after active management of labour. It was observed that quick and accurate clinical judgement and timely intervention can prevent maternal mortality. The role of a multidisciplinary team including primary health care provider, obstetrician, anaesthesiologist and critical care experts has significant effects on outcome especially in intractable cases.
急性子宫内翻是分娩第三产程中一种罕见的危及生命的并发症。在大多数情况下，确切病因不明。当胎盘娩出后出现出血、休克和伴有下推感的严重腹痛三联征时，应高度怀疑此病。即使在积极处理第三产程后也可能发生。诊断主要依靠临床。迅速手动复位子宫并同时大量使用宫缩剂是首选的治疗方法。本病例成功尝试了这种方法，一名26岁经产妇，无任何可识别的危险因素，在积极处理分娩后发生了急性产后子宫内翻。观察发现，快速准确的临床判断和及时干预可预防孕产妇死亡。包括初级卫生保健提供者、产科医生、麻醉师和重症监护专家在内的多学科团队的作用对结局有显著影响，尤其是在棘手的病例中。
