Abstract

Introduction

Puerperal uterine inversion is a rare event but a life threatening complication of 3^rd stage of labor in which uterus is turned inside out following delivery. It can produce severe postpartum hemorrhage (PPH) & maternal collapse.

Immediate reposition & resuscitation will save the patient & rarely laparotomy or hysterectomy may be needed. Sheehan’s Syndrome (SS) may follow severe PPH with hypotension which is due to ischemia of the arteries feeding the anterior pituitary. Prevalence of SS in India is 2.7 -3.9 %. Clinical signs & symptoms are related to the deficiency of the anterior pituitary hormones of which most common is amenorrhea & lactation failure. Management is by appropriate hormone replacement.

Case Summary

A28 year old lady from a poor family belonging to a state outside Kerala, had her 3^rd full term delivery at home developed acute inversion of uterus with severe bleeding. Taken to a nearby hospital immediately. Laparotomy was done there, could not correct inversion. Six units of blood transfused & referred to a higher center. Did not turn to any hospital due to shortage of money. As her parents are working in Kerala, she came to Kerala about two months after delivery. Brought to our institution after referring from a local hospital as chronic inversion of uterus. Previous two were home deliveries without any complications. Antenatal period uneventful according to the patient. No breast milk secretion after delivery.