Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan.
J Med Case Rep. 2022 May 14;16(1):190. doi: 10.1186/s13256-022-03419-2.
Acute puerperal uterine inversion is rare but may cause massive postpartum blood loss due to uterine atony. Therefore, these patients must be diagnosed, and uterine replacement must be performed as soon as possible. However, in some cases, active bleeding due to uterine atony becomes uncontrollable, even though the uterine inversion itself is treated. In these cases, additional treatments, including surgical procedures, are needed.
A 41-year-old Japanese woman, gravida 1, para 0, was hospitalized for labor induction at 40 weeks and 3 days of gestational age. She had a vacuum-assisted delivery after 3 days of oxytocin administration, but acute uterine inversion occurred. Although replacement of the inverted uterus was successful by manual repositioning and Bakri balloon tamponade insertion, massive postpartum hemorrhage caused by uterine atony became uncontrollable. In this situation, since disseminated intravascular coagulation had developed, we used uterine artery embolization to stop the bleeding. After detecting the pseudo-aneurysmal sac and tortuous vessels of the right uterine artery, transcatheter right-sided uterine artery embolization was performed. Thirteen days after uterine artery embolization, she was discharged with no complications.
In cases of disseminated intravascular coagulation caused by massive postpartum bleeding, uterine artery embolization may often be selected. In our case, since we performed angiography to detect the main bleeding site, the hemorrhage could be stopped with unilateral uterine artery embolization alone, without hysterectomy.
急性产后子宫内翻罕见，但可能因子宫收缩乏力导致大量产后出血。因此，这些患者必须尽快诊断并进行子宫复位。然而，在某些情况下，由于子宫收缩乏力导致的活动性出血变得不可控制，即使子宫内翻本身得到治疗。在这些情况下，需要额外的治疗，包括手术程序。
一名 41 岁日本女性，初产妇，经产妇 0，孕 40 周+3 天行催产素引产入院。催产素治疗 3 天后行真空辅助分娩，但发生急性子宫内翻。尽管通过手动复位和 Bakri 球囊填塞成功复位内翻的子宫，但因子宫收缩乏力导致的大量产后出血仍无法控制。在这种情况下，由于已发生弥散性血管内凝血，我们使用了子宫动脉栓塞术来止血。在检测到右侧子宫动脉的假性动脉瘤囊和迂曲血管后，进行了经导管右侧子宫动脉栓塞术。子宫动脉栓塞 13 天后，患者无并发症出院。
对于因大量产后出血引起弥散性血管内凝血的病例，常可选择子宫动脉栓塞术。在我们的病例中，由于我们进行了血管造影以检测主要出血部位，因此仅行单侧子宫动脉栓塞即可止血，无需行子宫切除术。
