Lakshmy S, Atmaja Nair, Sreedevi S
BACKGROUND Acute uterine inversion is a collapse of the uterine fundus into the cavity during the third stage of labour or immediately after delivery. It is a rare complication with an incidence of 1 in 2000 to 1 in 20000 deliveries. Shock is out of proportion to blood loss. WHO recommends hydrostatic correction if immediate manual repositioning fails. Hydrostatic method for reducing acute uterine inversion is a simple method with excellent outcome if advocated properly. The key to success of the hydrostatic correction is developing a good enough water seal to allow generation of adequate hydrostatic pressures for uterine replacement. A modification of hydrostatic method by using a condom catheter ensures an excellent water seal and helps to reduce failures during the procedure. The aim of this study was to use a condom catheter as a modification of hydrostatic method to correct cases of acute puerperal inversion so as to reduce failures during the procedure. MATERIALS AND METHODS This study was conducted as a prospective case series at Govt. Medical College, Kozhikode over a 10-year period from 01/01/2008 to 31/12/2017. All cases of acute uterine inversion managed at the hospital during this period were included. Cases of chronic inversion of uterus were excluded from the study. RESULTS There were 8 cases of acute inversion of uterus out of a total 1,59,102 births. All of them were multiparas and 6 cases were referred. 5 of them belonged to 26-30 years age group. 6 patients were having third degree inversion and 2 had fourth degree inversion. 6 patients were stable at the time of diagnosis, but 2 of them were in shock at the time of presentation. A total of 4 patients received blood transfusion. 2 patients were diagnosed with acute uterine inversion within 30 minutes of delivery. The remaining 6 cases reached our hospital at 1.5 to 2 hours after delivery. Two patients underwent immediate manual repositioning and six had hydrostatic correction using a condom catheter which was filled from a urobag filled with 2-2.5 litres of normal saline. All six cases were successfully corrected but two patients underwent emergency obstetric hysterectomy for PPH. CONCLUSION This modification of hydrostatic correction with condom catheter and urosac filled with normal saline is simple and effective and will definitely reduce maternal morbidity and mortality in cases of acute uterine inversion
