Inversion of the uterus after childbirth, with report of a case

Abstract

The cause of this accident when associated with neoplasms, and in the idiopathic cases and reinversions, is evidently in the uterus itself. The same mechanism, i.e., depression caused by some pathologic change in a portion of the uterine wall that interferes with the transmission of the wave of uterine contraction, introversion and perversion, readily accounts likewise for the puerperal cases when we take into consideration the greatly increased activity of the puerperal uterus. To explain inversio uteri simply upon a mechanical basis presupposes not only an atonic uterus but also one that is no longer susceptible of stimulation, as the external violence that might cause the inversion would prove a powerful stimulant of uterine tone.While the condition is rare, it is not so rare as it is commonly supposed to be. Such a possibility should always be borne in mind in the presence of profound shock or severe hemorrhage postpartum. The best treatment is the prompt institution of measures to combat shock, the replacement of the organ as soon as the condition of the patient permits, and the avoidance of infection. This is well illustrated by the mortality in the present series. In the hospital cases, where it is to be presumed the cases are recognized promptly and there are facilities for carrying out the treatment properly, the mortality was zero. In the group delivered in the home by physicians, where although the cases may be recognized promptly, there are not facilities for combating shock, the mortality was 12.5 per cent. In the group delivered by midwives where there was probably delay both in recognizing the condition and in instituting treatment, the mortality was 26 per cent.