Uterine rupture is an infrequent event, which exposes both the mother and the foetus at risk of death. We are reporting for the first time the occurrence of spontaneous uterine inversion associated with rupture at caesarean section. Etiological factors for uterine inversion were identified, including proposing a hypothesis relating this case. Technical aspects of manual reduction of the inverted uterus are discussed. Case Report A 25-year-old woman in her third pregnancy was admitted for induction of labour (IOL) at 39 weeks for intrauterine growth restriction (IUGR). She had one full term normal delivery, followed by semi-elective caesarean section at 38weeks of gestation for breech presentation complicated with IUGR. As there were no contraindications she was induced with 1mg of PGE2 gel intra-vaginally and foetal monitoring commenced. Four and half hours later, an obstetrician was asked to review the patient in view of severe abdominal pain. Her observations were normal and no vaginal bleeding seen. The patient was in acute pain despite given analgesia, with abdomen tender to touch. Foetal bradycardia dropped to 60 beats per minute, slowly recovering to 90. As uterine rupture suspected, immediate laparotomy under general anaesthesia was performed. Twelve minutes later by the Cohen's incision quick entry made into the abdominal cavity. There was fresh blood 1000–1200ml in the abdomen. The baby was found in the abdominal cavity wrapped in omentum. The uterus was completely inverted protruding through the ruptured scar with placenta still attached to it. The baby was untangled and delivered two minutes after incision and handed over to the paediatrician. The placenta was separated manually from the uterine fundus and removed. The inversion was corrected by continuous digital pressure to the cornual areas of the uterus and counter pressure at the ruptured scar edge (Figure). Reversion was accomplished over 2 minutes.Careful assessment of the uterus revealed 4cm extension upwards from its left angle of the ruptured scar. The uterus was reconstructed in two layers and remained well contracted. The total blood loss was estimated to be around 2500mls. During the operation and immediate postoperative hours the patient received four units of blood. She was closely monitored on the high dependency unit for 24 hours. The baby weighed 2800 grams at birth. Her APGAR scores at 1-5-10 minutes were 6-9-10. The cord blood gases recorded: arterial–pH 6.806 and venous–pH 6.815. The mother recuperated uneventfully from the operation and was discharged home with her baby on fifth postoperative day.
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