Uncontrollable uterine atony after replacement of uterine inversion managed by hysterectomy: a case report
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(2020) 14:181
CASE REPORT
Open Access
Uncontrollable uterine atony after replacement of uterine inversion managed by hysterectomy: a case report Daisuke Katsura1* , Suzuko Moritani2, Shunichiro Tsuji1, Kounosuke Suzuki1, Kazutaka Yamada1, Mizuki Ohashi1, Fuminori Kimura1 and Takashi Murakami1
Abstract Background: Uterine inversion may cause massive hemorrhage, resulting in maternal deterioration and death. Replacement of the inverted uterus must be performed as soon as possible. As time passes, the inverted uterus becomes atonic and necrotic, and a surgical approach may be required. Case presentation: A 27-year-old Japanese woman was admitted to our hospital 4 hours postpartum with increased hemorrhage after the replacement of an inverted uterus. Recurrent inversion was diagnosed, and though the atonic uterus was replaced again by the Johnson maneuver, hemorrhage persisted. Balloon tamponade was not successful in stopping the hemorrhage, and uterine artery embolization was performed. Bleeding resumed the next day on removal of the balloon, and hysterectomy was performed. Massive hemorrhage, coagulopathy, and uterine necrosis caused uterine atony, and the reperfused blood flow on replacement of the ischemic uterus increased hemorrhage. Conclusions: Cases of uterine inversion with coagulopathy lasting for more than 4 hours may require a surgical intervention, and uterine replacement may have to be delayed until the maternal hemodynamic condition is stabilized. Uterine replacement under laparotomy may be also be considered due to the risk of increased hemorrhage. Keywords: uterine inversion, replacement, atony of uterus, reperfused blood flow, ischemic uterus, case report
Background Although uterine inversion is a rare obstetric emergency and occurs in only 1 in 20,000 vaginal births, it causes acute maternal blood loss and can lead to maternal death [1]. Therefore, prompt management with fluid resuscitation and control of hemorrhage is important. In particular, the inverted uterus must be replaced as soon as possible because the success rate decreases with the involution of the cervix, which induces a rigid ring that * Correspondence: [email protected] 1 Department of Obstetrics and Gynecology, Shiga University of Medical Science Hospital, Setatsukinowa-cho, Otsu, Shiga 520-2192, Japan Full list of author information is available at the end of the article
makes restoration of the normal uterus position difficult [2, 3]. As time passes, the uterus becomes atonic and necrotic, and a surgical approach may be required [2–4]. However, the time from inversion to the occurrence of uterine atony and necrosis is uncertain. We encountered a case of a patient with increased hemorrhage and coagulopathy after the replacement of a uterine inversion that had persisted for 4 hours.
Case presentation A 27-year-old Japanese woman with unremarkable medical and family history was impregnated through in vitro fertilization. At 40 weeks of gestation, she was admitted
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