Acute puerperal uterine inversion. New approaches to management.

A retrospective review identified 56 patients with uterine inversion, from July 1977 through June 1986, from weekly obstetric statistics, delivery records and computerized discharge diagnoses. All patients underwent delivery by house officers, midwives or medical students under supervision. An analysis of the data revealed that the risk factors were primiparity, a fundally implanted placenta and delivery of a macrosomic fetus. Also, patients who received oxytocin with or without MgSO4 were at higher risk of puerperal inversion. MgSO4 by itself did not appear to be a risk factor. A placenta attached at the time of inversion appeared to have a protective effect against the development of shock. The use of betamimetics or MgSO4 appeared to be an acceptable alternative to general anesthesia in relaxing the uterus and aiding in its repositioning. Those agents were more likely to be successful in acute cases than in subacute ones and in second-degree inversion than in third-degree.