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Acute Uterine Inversion

Upside Down

Step 1: View clinicals

A 25 year old primipara presents at term for delivery; her pregnancy has been uncomplicated so far, and her medical and surgical histories are unremarkable. She delivers a healthy baby vaginally, followed by the complete placenta. Prophylactic oxytocin is administered. Six hours later, she starts to complain of severe lower abdominal pain and heavy vaginal bleeding.

Step 2: Order all relevant investigations

Ultrasound Abdomen & Pelvis

You realize that this would waste valuable time.

Full Blood Count

WBC/DC: 8,000/mm3 (4,600-11,000) Hb: 9.0 g/dL (11-18) Platelets: 380,000/mm3 (150,000-400,000)

Coagulation Profile

INR: 1.0 (0.9 - 1.3) APTT: 28 sec (24 - 35) TT: 12 sec (12-14)

Crossmatch Blood

Four pints of blood are crossmatched.

Step 3: Select appropriate management

Blood Transfusion
Manual Reduction
Internal Iliac Artery Ligation

Score: ★★☆