Rare Inversion Of Uterus – Variations Of Presentation

Inversion of Uterus is considered as an unusual entity that manifests itself in two forms namely acute and chronic forms. Acute form of inversion is normally observed at the time or subsequent to delivery leading to shock. At times, it is partial and asymptomatic during the course of childbirth or it might even slowly develop during the course of puerperium along with extended post-delivery blood loss.

The cited cases of puerperal uterine inversion observed was one in 1,860 women that underwent caesarean section or CS and was one among 3,737 women who underwent normal vaginal deliveries. The nonpuerperal inversion is atypical in nature with no printed figures made public in regards to its occurrence. It is normally linked with a rudimentary mild or malevolent uterine mass. A suspended tumour of the anatomy of the uterus could also be the reason. Seldom unprompted, inversion might take place in the older age bracket lacking neoplasm, possibly due to by and large atony.

There have been cited varied cases that have been observed with diverse modes of uterus presentation. Inversion of Uterus could be categorised into two classes namely puerperal and non-puerperal.  Puerperal uterine inversion is deemed amongst the grave complications in the field of obstetrics. The nonpuerperal uterine inversion is quite infrequent. Majority of the nonpuerperal cases are severe and analysis is quite tricky during physical examination.

The extent of uterine inversion could be incomplete, complete or total. Clinical examination of uterine inversion is complicated unless the palpitation of the fundal depression can be carried out during rectal exam. Idiopathic inversion is believed to be extremely rare.

Tumour or an idiopathic occurrence is known to cause nonpuerperal inversion. It is normally linked with uterine fibroid but uncommonly linked with uterine sarcoma. Clinical characteristics of chronic inversion comprise of severe, irregular and unnatural blood loss from vagina, anemia and pelvic distress. At times its occurrence may not be understood till the time of surgical intervention. The seemingly uncommon causes comprise of uterine tumours like sarcoma and the less generalised carcinoma as noted in nonpuerperal case. An unusual situation of severe nonpuerperal uterine inversion caused due to malignant varied mullerian tumour has also been cited.

Imaging methods like ultrasound and magnetic imaging resonance or MRI greatly assisted in detection of uterine inversion. MRI is quite pricy and not accessible in resource deficit countries. The treatment of uterine inversion is dependent on the pre-operative examination. Procedures like clamping and cutting the infundibulopelvic tendons is considered the foremost steps in averting an embolus caused due to pelvic congestion.

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