Acute uterine inversion at cesarean followed by combined “anaphylactoid syndrome” sequence and uterine atony

摘要

We describe a case of acute inversion and immediate reposition where the patient presented an intraoperative respiratory compromise, followed by hemodynamically instability that pre- ceded the clinically observed uterine atony and bleeding. Rapid and facile reposition of the uterus did not lead to improvement of the hemodynamic status, which was achieved only after prolonged respiratory support and coagulation correction. The clinical pre- sentation and the timing of the events recapitulated the sequence described for the “anaphylactoid syndrome of pregnancy”/amniotic fluid embolism (ASP/AFE) in combination with uterine atony. We thus pursued to review of the literature in order to evaluate the relation between the acute inversion at cesarean and the “anaphylactoid syndrome of pregnancy “in addition to the expected atony; such a relation would impact on the immediate therapy.