Eversion of the uterus (inversio uteri)

Among the complications succession and the postpartum period not to mention the eversion of the uterus, with which the obstetrician-gynecologist, however, in very rare cases, have to meet (Fig. 120). Enjoyed our Institute, one eversion account for 450 000 births; according to the maternity hospital of a name Snegireva in Leningrad, one falls on eversion of 300,000 births.


Fig. 120. Full eversion of the uterus (Pankova).
1 - the fallopian tube; 2 - anularea part of the fallopian tube; 3 - ovary.

There are vivorata "acute" and "chronic" with duration of 6 days (Kehrer), 4 months (Grossmann) and 20 years (Chawarski).
The mechanism of inversion. Eversion of the uterus entails changing regulations and forms, in which internal surface becomes the outer and the outer - to the inner. Eversion occurs immediately after birth or later; in very rare cases eversion occurs outside of pregnancy. First of all cases eversion considered violent, i.e. a consequence of incompetent and rude use of the treatment benefit (stretching over the umbilical cord, the method of the Vendor, which is especially dangerous in cases dense connection of the placenta from the uterus). A contributing factor to this is the location of the placenta in the bottom of the uterus, which was much more common in nulliparous. Nagaragawa placenta is commonly located on the front or back wall of the uterus, resulting eversion is less common. However, Beckman (1894) believed that spontaneous vivorata occur more frequently violent.
Eversion occurs only when the conditions that, when properly functioning the uterus usually absent. One of such conditions, in all probability, is the change of the functional properties of the uterus, namely the loss of her tone, the so-called uterine atony. The origins of the uterus atonia is the inferiority of the tissues in the last structural-morphological respect. In addition, at the same time, of course, upset the correct innervation relations of the sympathetic and parasympathetic nervous systems, directing and regulating the work of the neck and the lower part of the uterus. In such cases, the eversion easily occurs under the influence of various factors in the increase in intra-abdominal pressure. This so-called spontaneous eversion of the uterus.
The eversion of the uterus contribute anomalies location and attach the placenta, which, falling into the lower segment of the uterus, because of their gravity drags and connected with it by a part of the upper section of the uterus. Once this depressed part of the uterus reaches the internal OS, starts shrinking ring of muscle fibers of the lower uterine segment due to mechanical irritation, under whose influence stretched part of the uterus or pushed on, or comes back. It is thus not surprising that some manipulation of the uterus (for example, the Vendor) or last (stretching over the umbilical cord) contribute to the emergence of inversion. Much less eversion is caused by tumors emanating from the walls of the uterus, whether fibromatous node, sarcoma, etc.
In the development of the eversion distinguish several stages. At the beginning there are only a protrusion of the fundus of the uterus, which does not reach the external OS. Then the protrusion (like fingers turned gloves) may increase so that the body of the uterus is in front of the external OS, and, finally, comes vihodnie uterine already beyond the vaginal tube - so-called loss of inverted uterus.
Eversion is rarely so full that it was involved lower part of the cervical canal. Commonly ring throat and the lower part of the cervical canal for a few millimeters in height persist even with full inversion and only then participate in it, when bottom strongly pulled the body of the uterus.
In the recess formed on the place of former convexity of a body of the uterus, the so-called "funnel eversion", are drawn into the fallopian tubes, round and wide uterine ligaments. The ovaries and intestinal loops are in the funnel only in acute cases, but usually they are out of the funnel eversion.
Often turned on the surface of the uterus has neugenisis the placenta.
Time of occurrence are distinguished: 1) a sharp, sudden onset of ectropion; 2) chronic, gradually formed eversion.
The pathogenesis: 1) vivorata in puerperas with normal pregnancy; 2) vivorata oncogenetic (when the submucosal fibroids).
In addition, there are 1) spontaneous eversion and 2) enforced eversion resulting from incompetent and rude obstetric intervention.
The clinical picture sudden onset of acute eversion is manifested quite alarming symptoms: acute pain, collapse (rapid pulse, pale face, fainting, cold sweat) and bleeding. Acute pain arises because of peritoneal irritation and tension of ligaments of the uterus due to changes in the topographical position of the authorities. The phenomenon of shock are developing on the ground sharp injuries peritoneal related, maybe with a rapid fall in intraperitoneal pressure.
Of considerable importance in the development of the clinical picture is irritation of the sympathetic nervous system.
Inverted uterus is represented in the form of a tumor bright red color outside of the genital slit or vagina. When considering the tumor can be found on her openings of the fallopian tubes. In recent cases eversion the bottom of tumors in the lumbar hand easily pressed inside. As already noted above, the placenta or is in connection with uterine wall or partial; in the latter case can be severe bleeding from open placental vessels. Bleeding supported existing venous stagnation due to obstruction of the outflow of venous blood because of crater eversion. In some cases, bleeding is quite large.
The prediction is very seriously; spontaneous reset eversion rather doubtful, although it is and there are indications in the literature. Mortality, according to literary data, ranging from 6%to 20%.