Abstract:
BACKGROUND:Puerperal uterine inversion is a rare, potentially life-threatening obstetrical emergency. The current literature consists of small case series and a single nationwide study from Europe with only 15 cases. OBJECTIVE:We aimed to define the incidence, temporal trends, and outcomes in women with uterine inversion using a nationally representative US cohort. STUDY DESIGN:We used the Nationwide Inpatient Sample, a 20% sample of US hospital admissions, to identify all deliveries from 2004 through 2013. International Classification of Diseases, Ninth Revision diagnosis codes were used to identify cases of uterine inversion and associated adverse outcomes (maternal death, blood transfusion, maternal shock, need for surgical correction, and length of hospital stay). The incidence of uterine inversion overall and for each year of the study period was calculated with 95% confidence intervals. The case fatality and incidence of other adverse outcomes among women with a uterine inversion were also estimated. RESULTS:Among 8,294,279 deliveries in 2004 through 2013, there were 2427 cases of puerperal uterine inversion, corresponding to an incidence of 2.9 per 10,000 deliveries (95% confidence interval, 2.8-3.0). There was 1 maternal death in our cohort (4.1 per 10,000 events). No change in the incidence of uterine inversion over the study period was detected. Among women with a uterine inversion, 37.7% (95% confidence interval, 35.8-39.6%) had an associated postpartum hemorrhage, 22.4% (95% confidence interval, 20.7-24.0%) received a blood transfusion, and 6.0% (95% confidence interval, 5.1-7.0%) required surgical management. Only 2.8% (95% confidence interval, 2.1-3.5%) underwent a hysterectomy. The median length of hospital stay was 3 days. CONCLUSION:This study provides the largest population-based results on puerperal uterine inversion to date and highlights the high likelihood of adverse maternal outcomes associated with the condition. The results inform the optimization of clinical management, by preparing for possible postpartum hemorrhage, need for blood products, and surgical management in the rare event of uterine inversion.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Coad SL,Dahlgren LS,Hutcheon JAdoi
10.1016/j.ajog.2017.05.018subject
Has Abstractpub_date
2017-09-01 00:00:00pages
377.e1-377.e6issue
3eissn
0002-9378issn
1097-6868pii
S0002-9378(17)30627-0journal_volume
217pub_type
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journal_title:American journal of obstetrics and gynecology
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pub_type: 临床试验,杂志文章
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pub_type: 临床试验,杂志文章,随机对照试验
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pub_type: 临床试验,杂志文章,评审
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
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更新日期:2010-04-01 00:00:00