Inversion of Uterus in Northern India – Case Based Experience of 25 years

Uterine inversion is turning of uterus inside out and upside down. Serosal layer becomes innermost layer, the endometrium outermost layer and uterine fundus becomes most dependent part, if it is complete inversion. It’s rare but dreadful condition. Exposed, enlarged endometrium may produce excessive vaginal bleeding and are more prone for infection. These cases usually present with severe anemia. It most commonly occurs following delivery and is termed as ‘puerperal uterine inversion’. It may present without pregnancy with sub mucus fundal fibroid and termed as ‘non-puerperal uterine inversion’. Inversion is termed acute when it is within 24 hours, sub-acute when it is presents after 24 hours but less than four weeks postpartum and chronic when more than 4 weeks postpartum. In time span of 25 years, we encountered 4 cases of acute inversion and 4 cases of chronic inversion. Out of 4 cases of acute inversion, 3 cases were reposed successfully, and one died within few minutes of arrival. Out of 4 cases of chronic inversion of uterus, one was of gynecological origin in a young nulliparous lady with big sub mucus fibroid. Fibroid was excised out vaginally and inversion was corrected by Haultain’s method. Another case of chronic inversion of puerperal origin was reposed successfully by Kustner’s method vaginally. Later, she delivered a baby normally. Again, one was an obstetric case, operated by Haultain’s method by abdominal route. None of them reported later with relapse. One case of chronic inversion refused admission and absconded. All cases were within 20-30 years of age. All cases were severely anemic and needed blood transfusion prior to surgery. Acute inversion, which occasionally occurred during cesarean section and reposed immediately, has not been included in the study.