Acute Inversion of the Uterus

Kai Tiaki : the journal of the nurses of New Zealand, Volume II, Issue 4, 1 October 1909, Page 164

Acute Inversion of the Uterus

Acute inversion of the uterus is^said to occur in one out of 180,000 labours, and amongst the many misfortunes which may happen to a practising midwife, it is a matter of thankfulness that this terrifying disaster is not more frequent. A case is, however, related in the " British Medical Journal " for 23rd January, by Dr. Alan Holthusen, as occurring recently in his practice. The patient was a primipara, who had been in labour fourteen hours before delivery with forceps, but there was no special difficulty about this. Only one contraction of the uterus took place in the first half-hour after the birth of the child, and ergot was given hypodermically. Half-an-hour afterwards there was a sudden and violent contraction, immediately followed by the protrusion from the vulva of the inverted uterus, with the placenta attached. Very little haemorrhage had occurred up to this point. The placenta was easily and quickly peeled off the inverted fundus, which was at once pushed back by the doubled-up fist. The patient now became very collapsed, in fact, unconscious, with a flickering and uncountable pulse and a considerable amount of haemorrhage. The uterus made no attempt at contraction, and became re-inverted if the hand was withdrawn. Ergot was again administered, also strychnine, and two

pints of saline infusion were injected into a vein. The uterus was meanwhile controlled by bimanual compression, and the patient gradually recovered from the shock, after which normal contraction took place and haemorrhage ceased. Recovery was uneventful. In this case the cord was abnormally short, only 13.1 inches, and was coiled once round the child's body, leaving only six inches free. This fact caused the fund us to be unknowingly pulled upon during the delivery by forceps, the child's weight causing further traction, and thus the fundns with placenta attached was drawn down into the uterine cavity, and there acted as a foreign body. When the next contraction occurred it naturally expelled the foreign body so that fundus and placenta appeared at the vulva. After the placenta was peeled off and the fundus replaced, haemorrhage followed, because the uterus was now in a state of relaxation and the general condition of collapse contributed to its continuance. Dr. Holthusen states that the alarming condition of shock was out of all proportion to the amount of haemorrhage, which was altogether less than two pints. It is satisfactory that the patient made such a good recovery, the involution of the uterus proceeding quite normally.