Sunday, September 11, 2011

Uterine Inversion


Definition
Inversion of the uterine is a condition in which the inner lining of the uterine (endometrium) down.


Etiology
Total inversion of the uterine after the fetus was born almost always caused by a strong pull on the cord attached to the placenta is implanted in the fundus. Incomplete uterine Inversion can also occur. Who had a role in uterine inversion is a strong umbilical cord and not easily separated from the placenta plus the pressure on the uterine fundus and a weakness, including the lower uterine segment and cervix.


Diagnosis
Uterine Inversion marked with signs of shock from the pain, the vulva appears endometrium reversed with or without the placenta still attached. When a new case, then the prognosis is quite good but if it happens long enough, then the smaller cervical tongs will make uterine ischemia, necrosis, and infection.


Treatment
Assistant, including anesthesiologists, immediately summoned.
Newly experienced uterine inversion with placenta that has separated may easily be restored by way of pushing the fundus with the palm of the hand and fingers pointing to the long axis of the vagina. Two systems should be installed by intravenous infusion, and patients were given Ringer's lactate solution and blood to overcome hypovolaemia. If still attached, the placenta should not be released until the drip system is installed, fluid flow, and anesthesia (halothane or enflurane should) have been given. Tokolitic drug, such as terbutaline, ritodrin, or magnesium sulphate is used for uterine relaxation and repositioning. Meanwhile, the uterine inversion, when her prolapsed beyond the vagina, inserted into the vagina. After the placenta is removed, the palm of the hand is placed in the center of the fundus with the finger extension was to identify the edges of the cervix. Then done by hand so that pressure driven fundus upward through the cervix. Immediately after the uterine is returned to its normal position, a drug used for relaxation is stopped and simultaneously patients were given oxytocin for uterine contraction while maintaining operator in the normal fundus.
If the uterine can not be repositioned by manipulation of the vagina due to a constricting ring of thick, mandatory laparotomy. Taken together, the fundus can then be driven from below and pulled from above. If the constriction ring still hamper reposition, carefully incised on the posterior cervix to fundus exposed. After fundus repositioned, anesthetic drug used to relax the myometrium is stopped, oxytocin infusion started, and uterine incision repair.

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