Marlina Dina, Susandi Dadan, Utomo Aditya
Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran - Dr. Slamet General Hospital, Garut, Indonesia.
SAGE Open Med Case Rep. 2024 Jul 27;12:2050313X241266582. doi: 10.1177/2050313X241266582. eCollection 2024.
Uterine inversion is characterized by the folding of the fundus into the uterine cavity. While infrequent, it ranks among the most serious complications of childbirth, posing a significant risk of mortality primarily due to hemorrhage and shock. Retained placenta after vaginal delivery is diagnosed when placenta does not spontaneously deliver within 18-60 min. Manual placenta can be considered first if retained placenta occurs. A 29-year-old woman with parity status P2A0 came to maternal emergency referred from the first health care provider with severe post-partum hemorrhage after delivering her second living 3100 g baby 2 h before admission. The midwife reported that the placenta was hard to have. There was a resistance felt inside when she tried to do umbilical cord traction. The manual placenta was not done. After several trials, the placenta finally came out, followed by fundus of uterine. Acute hemorrhage occurred, causing a decrease of hemoglobin level to 7.8 g/dl. At maternal emergency, the placenta delivered spontaneously yet the fundus still inverted. Fast reposition of uterine done by doctor on duty to stop the hemorrhage. Following successful repositioning and 4 days of observation, the patient was discharged from the hospital with no signs of hemorrhage and favorable results on abdominal ultrasonography.
子宫内翻的特征是子宫底部折叠进入子宫腔。虽然不常见，但它是分娩最严重的并发症之一，主要由于出血和休克而具有显著的死亡风险。阴道分娩后胎盘滞留是指胎盘在18 - 60分钟内未自然娩出。如果发生胎盘滞留，可首先考虑人工剥离胎盘。一名29岁、孕产史为P2A0的妇女，在入院前2小时产下第二个体重3100克的活婴后，因严重产后出血被第一保健提供者转诊至产妇急诊。助产士报告说胎盘很难娩出。当她试图进行脐带牵引时，感觉到内部有阻力。未进行人工剥离胎盘。经过几次尝试，胎盘最终娩出，随后子宫底部也娩出。发生急性出血，导致血红蛋白水平降至7.8克/分升。在产妇急诊时，胎盘自然娩出，但子宫底部仍内翻。值班医生迅速进行子宫复位以止血。在成功复位并观察4天后，患者出院，无出血迹象，腹部超声检查结果良好。
