Management of Acute and Subacute Puerperal Uterine Inversion with Intravenous Nitroglycerin

Abstract

Background: Uterine inversion is an unpredictable entity, with more than one-half of cases reported without detectible precipitants. Hemorrhage can be rapid and life-threatening, requiring prompt recognition and aggressive management. Cases:Case 1: A 25-year-old female, para 1, with complete uterine inversion presented as a case of postpartum hemorrhage and this was managed successfully with intravenous (IV) nitroglycerine. Case 2: A second case involved partial uterine inversion, in a 22-year-old female, para 1, who had a retained placenta. The inversion was not corrected by anesthesia but was corrected by IV nitroglycerine without any side-effects. Results: Both cases were treated successfully with the use of IV nitroglycerin. Both women had postpartum hemorrhage caused by uterine inversion. IV nitroglycerin was found to be effective and was not associated any adverse effects. Conclusions: General anesthetics are generally used for uterine relaxation in cases of uterine inversion but these agents are associated with serious side-effects. Nitroglycerin is a useful tool in the obstetrical armamentarium. Its short duration of action and rapid absorption make it ideal for expeditious uterine and cervical relaxation. Gynecologists and obstetricians should become familiar with the agents in the gynecology armamentarium so that major surgery can be prevented in cases like the ones described in this article. (GYNECOL SURG 31:104)