Kurniawati Eighty Mardiyan
Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
Int J Surg Case Rep. 2022 May;94:107076. doi: 10.1016/j.ijscr.2022.107076. Epub 2022 Apr 12.
Uterine inversion is a rare case but can lead to maternal death. Treatment options start from repositioning the uterus to surgery. Surgery should be prevented because this procedure is associated with complications and long-term effects on women. A case report describes the use of condom chateters in the management of bleeding due to uterine inversion.
Mrs. SIM, a 35-year-old secondary primigravida woman, was referred from the midwife's independent practice 3 h after her third delivery with a diagnosis of uterine prolapse and hypovolemic shock. The patient successfully underwent a manual placenta but part of her uterus turned inside out accompanied by bleeding. At the referral hospital, the patient was diagnosed with uterine inversion. The main action is to reposition the uterus, then maintain it with internal bimanual compression. After the patient's perineum was sutured, the patient was observed for uterine contractions and given antibiotics. The patient had intermittent uterine contractions and bleeding therefore she was initiated to insert a condom catheter. The patient showed signs of improvement in her general condition and no active bleeding was found.
An accurate diagnosis needs to be made early so that there is no misdiagnosis between uterine prolapse and uterine inversion. Good teamwork is needed in case management. It is necessary to approach both primary and tertiary health facilities for case screening and initial management.
Condom catheters can be helpful in the management of uterine inversion, particularly in stopping bleeding.
子宫内翻是一种罕见病例，但可导致孕产妇死亡。治疗方案从子宫复位到手术不等。应避免手术，因为该手术会引发并发症并对女性产生长期影响。一份病例报告描述了避孕套导管在治疗子宫内翻出血中的应用。
西姆夫人，一名35岁的经产妇，在第三次分娩后3小时从助产士独立诊所转诊而来，诊断为子宫脱垂和低血容量性休克。患者成功进行了人工剥离胎盘，但部分子宫翻出并伴有出血。在转诊医院，患者被诊断为子宫内翻。主要措施是将子宫复位，然后通过双手内压法维持复位状态。在缝合患者会阴后，观察患者子宫收缩情况并给予抗生素。患者子宫间歇性收缩且有出血，因此开始插入避孕套导管。患者的一般状况显示出改善迹象，未发现活动性出血。
需要尽早做出准确诊断，以免在子宫脱垂和子宫内翻之间出现误诊。病例管理需要良好的团队协作。有必要联系一级和三级医疗机构进行病例筛查和初始管理。
避孕套导管有助于子宫内翻的治疗，尤其是在止血方面。
