In this day and age, with the advancement of treatments and the strong campaign to discourage home deliveries, chronic uterine inversion is now considered an uncommon but life-threatening obstetric condition. In this report, we present a case of a 17-year-old primipara, who sought consultation due to prolonged and heavy vaginal bleeding. Upon speculum examination, a knob-like, fleshy, hyperemic, smooth mass, approximately 6 cm × 5 cm × 4 cm, was seen occupying the upper third of the vaginal canal. On internal examination, a globular mass was felt protruding through the cervix, which bleeds easily on manipulation. Uterine corpus was neither appreciated on both abdominal and rectovaginal examination. The patient was admitted and managed as a case of chronic uterine inversion, which was further confirmed by a sonogram. Successful repositioning of the uterus was achieved after trying different established techniques and procedures in the attempts at maneuvering the chronically inverted uterus.
Uterine Inversion

Uterine inversion is a rare clinical problem. Most cases of uterine inversions are puerperal inversions wherein it is encountered as an obstetric emergency, and sometimes a diagnostic challenge in gynecology. Uterine inversions associated with malignancies such as endometrial carcinoma and sarcoma are even rare. We report 2 cases of this rare condition. A 55 year old diagnosed with endometrial carcinoma and a 60-year-old woman diagnosed with sarcoma (malignant mixed mullerian tumor) presented with mass protruding from the vaginal introitus. The diagnosis of complete uterine inversion was confirmed in both cases during laparotomy. Total abdominal and vaginal hysterectomy and bilateral salpingo-oophorectomy, bilateral pelvic lymph node dissection, paraaortic lymph node sampling was done. It required a challenging surgical procedure to remove the tumor along with the review of literature especially of its association with malignancies.
Female ; Uterine Inversion ; Uterine Neoplasms ; Adenocarcinoma

Chronic puerperal uterine inversion is a rare and life-threatening obstetric emergency which requires emergent treatment. We present a case of a 27-year-old Gravida 2 Para 2 (2002) with chronic uterine inversion. A bleeding, 4 x 4 x 5 cm fleshy knob like mass protruding from the cervix, was seen during vaginal inspection. Two-dimensional transvaginal sonography and 3-dimensional imaging clinched the diagnosis of uterine inversion. The patient underwent Haultain's procedure and was discharged improved with resumption of normal menses. Postpartum transvaginal sonography revealed a normally positioned uterus.

Chronic puerperal uterine inversion is a rare and life-threatening obstetric emergency which requires emergent treatment. We present a case of a 27-year-old Gravida 2 Para 2 (2002) with chronic uterine inversion. A bleeding, 4 x 4 x 5 cm fleshy knob like mass protruding from the cervix, was seen during vaginal inspection. Two-dimensional transvaginal sonography and 3-dimensional imaging clinched the diagnosis of uterine inversion. The patient underwent Haultain's procedure and was discharged improved with resumption of normal menses. Postpartum transvaginal sonography revealed a normally positioned uterus.

We report a non-puerperal uterine inversion with nulliparous women caused by huge pedunculated submucosal fibroid. Massive bleeding from protruding mass through vagina brought the heart to stop in 42-year-old nulliparous woman. She became cardiopulmonary resuscitation survivor in emergency room and then underwent laparotomy which ended in successful myomectomy rather than hysterectomy considering her demand for future fertility. Meticulous and adequate fluid therapy and transfusion was also administered to recover from hypovolemic status. Pathologic report confirmed benign submucosal fibroid with degeneration, necrosis and abscess formation. Thus, clinician should be aware of uterine inversion when encountered with huge protruding vaginal mass and consider uterus-preserving management as surgical option when the future fertility is concerned.
Abscess ; Adult ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Female ; Fertility ; Fluid Therapy ; Heart ; Hemorrhage ; Humans ; Hypovolemia* ; Hysterectomy ; Laparotomy ; Leiomyoma ; Necrosis ; Shock* ; Survivors ; Uterine Inversion* ; Vagina

We report a case of unrecognized uterine inversion was restored spontaneously without surgical intervention. Initially, the case was diagnosed as uterine atony and not uterine inversion and was managed successfully with uterine artery embolization. However, a partial uterine inversion was detected on a subsequent scheduled pelvic examination. Fortunately, her uterus was completely restored without any surgical intervention on eighth week after delivery.
Gynecological Examination ; Postpartum Hemorrhage ; Uterine Artery Embolization ; Uterine Inertia ; Uterine Inversion* ; Uterus

The correct diagnosis and management of patients with uterine inversion will always remain as a challenge to any obstetrician. Two cases of puerperal uterine inversion managed differently are presented. In the first patient, there was delay in the diagnosis of uterine inversion and patient had to undergo hysterectomy. In contrast, there was early recognition of uterine inversion in the second patient prompting immediate manual repositioning.

Uterine leiomyomas are the most common uterine tumors. They are estimated to be present in approximately 20% of all women of reproductive age. They may be present in subserosal, intramural, or submucosal in location within the uterus, or located in the cervix, in the broad ligaments, or on a pedicle. Many studies report that the malignant potential of a preexisting uterine leiomyoma is extremely rare, occuring in less than 0.5%. Uterine leiomyomas may cause a range of syptoms, for example, severe anemia from abnormal uterine bleeding, dysmenorrhea, constipation from rectosigmoid compression, dysuria, frequency, residual sensation due to bladder compression. Patients with those symptoms or "cancer phobia" should be treated. Rare but severe symptoms associated with uterine leiomyomas are rectosigmoid compression, with intestinal obstruction, thrombophlebitis of lower extremities from venous stasis, polycythemia, ascites, severe pain from torsion and infection of prolapsed pedunculated submucosal myoma and uterine inversion from prolase of pedunculated submucosal leiomyoma. Now we report a rare case of uterine inversion resulted from prolapse of huge pedunculated uterine submucosal leiomyoma, which caused hypovolemic shock due to massive uterine bleeding.
Anemia ; Ascites ; Broad Ligament ; Cervix Uteri ; Constipation ; Dysmenorrhea ; Dysuria ; Female ; Humans ; Intestinal Obstruction ; Leiomyoma* ; Lower Extremity ; Myoma ; Polycythemia ; Prolapse* ; Sensation ; Shock ; Thrombophlebitis ; Urinary Bladder ; Uterine Hemorrhage ; Uterine Inversion* ; Uterus

The management of postpartum hemorrhage remains one of the significant challenges to clinical practitioners of obstetrics. Massive postpartum hemorrhage is a major cause of maternal death and morbidity. Early postpartum hemorrhage refers to bleeding within the first 24 hours after delivery; late of delayed postpartum hemorrhage occurs more than 24 hours but less than six weeks after delivery. Uterine atony remains the most common cause with many patients presenting with no known risk factors. Postpartum bleeding can result from uterine atony, genital tract lacerations or hematomas, retained placenta, uterine inversion and acquired or inherited coagulopathies. Every obstetrics unit should have protocols available to deal with hemorrhage and have specific guidelines for patients who object to blood transfusions for various reasons. Placement and utilization of arterial catheters for uterine artery embolization is becoming more widespread. Timely hysterectomy should be performed for signs of refractory bleeding. Application of medical and surgical principles combined with recent new technologic advances will help the obstetrician avoid disastrous outcomes for both mother and fetus.
Blood Transfusion ; Catheters ; Fetus ; Hematoma ; Hemorrhage ; Humans ; Hysterectomy ; Lacerations ; Maternal Death ; Mothers ; Obstetrics ; Placenta, Retained ; Postpartum Hemorrhage* ; Postpartum Period* ; Risk Factors ; Uterine Artery Embolization ; Uterine Inertia ; Uterine Inversion

Uterine inversion is a rare but a potentially fatal complication of labor, and may occur in the third stage of labor. Because it can lead to shock and hemorrhage, immediate management should be attempted to replace the inverted uterus. We report a case in which uterine inversion was not replaced by manual manipulation, but which was successfully replaced by the induction of general anesthesia.
Anesthesia, General* ; Hemorrhage ; Shock ; Uterine Inversion* ; Uterus