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[Case report of 39-Year-Old Gravida III, Para III with Inverted Uterus after Breech Birth].

Abstract：

:An inverted uterus is defined as the eversion of the uterus into the vagina. It is a very rare event but has to be treated as an emergency. A woman with an inverted uterus is in serious danger of developing atony with high blood loss in a short time. This can lead to hypovolemic shock and circulatory failure. Therapy includes urgent uterine repositioning under narcosis and curettage after manual abruption of the placenta. Afterwards, uterotonics such as prostaglandins should be administered. A disorder of the coagulation system is very common due to blood loss. Therefore, substitution of plasma components and antifibrinolytic drugs are recommended. If vaginal repositioning of the uterus cannot be achieved, laparotomy or hysterectomy are possible alternatives. We report the case of a 39 year-old gravida III, para III in the 36+3 gestational week who, after a spontaneous breech delivery with placenta accreta, experienced an inverted uterus, which was then repositioned. :Die Inversio uteri bezeichnet das Umstülpen der Gebärmutter in die Scheide postpartal. Sie ist äußerst selten, aber stellt einen geburtshilflichen Notfall dar. Die Gefahr für die Gebärende besteht in einer Uterusatonie mit dem Verlust großer Mengen Blut in kurzer Zeit. Dies kann, wenn keine rechtzeitige Therapie erfolgt, zum hypovolämischen Schock bis zum Herz-Kreislaufversagen führen. Die Therapie erfolgt durch eine Uterus-Reposition in Vollnarkose mit anschließender manueller Plazentalösung. Anschließend folgen die Kürettage und die Gabe von hochpotenten Uterotonika wie Sulproston. Durch den in der Regel hohen Blutverlust kommt es häufig zu einer Störung des Gerinnungssystems, sodass eine Substitution von Antifibrinolytika wie Tranexamsäure, Gerinnungsfaktoren und/oder Erythrozytenkonzentraten erforderlich wird. Gelingt keine vaginale Reposition des Uterus, so bleiben als Ultima Ratio nur die Reposition per Laparotomie oder die Hysterektomie. Wir berichten über eine 39-jährige III. Gravida, III. Para mit 36+3 Schwangerschaftswochen (SSW), bei der es nach spontaner Steißgeburt bei Placenta accreta zur Inversio uteri kam, die vaginal reponiert werden konnte.

journal_name

Z Geburtshilfe Neonatol

journal_title

Zeitschrift fur Geburtshilfe und Neonatologie

authors

Findeklee S

doi

10.1055/a-0828-8696

subject

Has Abstract

pub_date

2020-02-01 00:00:00

pages

38-41

issue

1

eissn

0948-2393

issn

1439-1651

journal_volume

224

pub_type

杂志文章

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