Wendel P J, Cox S M
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA.
Obstet Gynecol Clin North Am. 1995 Jun;22(2):261-74.
Puerperal inversion of the uterus is an unusual and potentially life-threatening event occurring in the third stage of labor, but when managed promptly and aggressively inversion can result in minimal maternal morbidity and mortality. Once the diagnosis of inversion is made, measures should be undertaken to manage and correct acute blood loss and potential shock. In conjunction with anesthesia personnel, immediate uterine replacement should be considered. Uterine relaxants (MgSO4, terbutaline, or halothane) can be used if initial attempts fail; however, in the majority of patients successful immediate replacement without use of uterine relaxants is possible. The choice of anesthetic agent and uterine relaxants should be individualized based on the clinical scenario. Following manual replacement, massage and ecbolic agent(s) should be instituted immediately to prevent reinversion. Surgical repositioning via an abdominal or vaginal approach may be necessary in subacute or chronic inversions.
产后子宫内翻是分娩第三阶段发生的一种罕见且可能危及生命的事件，但如果及时且积极地处理，子宫内翻可使产妇发病率和死亡率降至最低。一旦确诊为子宫内翻，应采取措施处理和纠正急性失血及潜在休克。应与麻醉人员协作，考虑立即进行子宫复位。如果初次尝试失败，可使用子宫松弛剂（硫酸镁、特布他林或氟烷）；然而，大多数患者在不使用子宫松弛剂的情况下即可成功立即复位。麻醉剂和子宫松弛剂的选择应根据临床情况个体化。手法复位后，应立即进行按摩并使用催产剂以防止再次内翻。对于亚急性或慢性内翻，可能需要通过腹部或阴道途径进行手术复位。
