A case of third degree hemorrhagic shock due to total subacute uterine inversion after delivery

  • William Timotius Wahono Puruk Cahu General Hospital, Central Kalimantan, Indonesia http://orcid.org/0000-0002-6269-6969
  • Angela Putri Puruk Cahu General Hospital, Central Kalimantan, Indonesia https://orcid.org/0000-0002-7064-6283
  • Yudianto Budi Saroyo Department of Obstetrics and Gynecology, Universitas Indonesia, Jakarta, Indonesia
  • Antonius Joko Nugroho Puruk Cahu General Hospital, Central Kalimantan, Indonesia
  • Ruth Sally Puruk Cahu General Hospital, Central Kalimantan, Indonesia
  • Sugianto Parulian Simanjuntak Puruk Cahu General Hospital, Central Kalimantan, Indonesia
  • Samuel Puruk Cahu General Hospital, Central Kalimantan, Indonesia
Keywords: postpartum hemorrhage, risk factor, uterine inversion
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Uterine inversion is a rare, but life-threatening obstetric emergency. We describe a case of total subacute uterine inversion in settings with limited resources. A multiparous (P4) 29-year-old woman with history of delivery assisted by a traditional birth attendant who used the fundal pressure technique 4 days before admission was referred due to postpartum hemorrhage. She had low blood pressure, tachycardia, and lethargic. A protruding mass from the vaginal introitus with active bleeding was visible. She diagnosed with third degree hemorrhagic shock due to total subacute uterine inversion. Resuscitation was initiated immediately and manual uterine repositioning was performed under general anesthesia. After two failed attempts, a laparotomy was performed to apply traction to the round ligaments and an incision on the cervical ring by using Allis clamps. The inversion was resolved. Next, subtotal hysterectomy was done to stop bleeding and infection.


  1. Leal RF, Luz RM, de Almeida JP, Duarte V, Matos I. Total and acute uterine inversion after delivery: a case report. J Med Case Rep. 2014;8:347. https://doi.org/10.1186/1752-1947-8-347

  2. Witteveen T, Van Stralen G, Zwart J, van Roosmalen J. Puerperal uterine inversion in the Netherlands: a nationwide cohort study. Acta Obstet Gynecol Scand. 2013;92(3):334-7. https://doi.org/10.1111/j.1600-0412.2012.01514.x

  3. Coad SL, Dahlgren LS, Hutcheon JA. Risks and consequences of puerperal uterine inversion in the United States, 2004 through 2013. Am J Obstet Gynecol. 2017;217(3):377.e1-6. https://doi.org/10.1016/j.ajog.2017.05.018

  4. Dwivedi S, Gupta N, Mishra A, Pande S, Lal P. Uterine inversion: a shocking aftermath of mismanaged third stage of labour. Int J Reprod Contracept Obstet Gynecol. 2016;2(3):292-5. https://doi.org/10.5455/2320-1770.ijrcog20130907

  5. Pauleta JR, Rodrigues R, Melo MA, Graça LM. Ultrasonographic diagnosis of incomplete uterine inversion. Ultrasound Obstet Gynecol. 2010;36(2):260-1. https://doi.org/10.1002/uog.7735

  6. Livingston SL, Booker C, Kramer P, Dodson WC. Chronic uterine inversion at 14 weeks postpartum. Obstet Gynecol. 2007;109 (2 Pt2):555-7. https://doi.org/10.1097/01.AOG.0000252260.11235.33

  7. O'Grady JP. Malposition of the uterus [Internet]. Medscape. 2018 [cited 2019 Feb 22]. Available from: https://emedicine.medscape.com/article/272497-overview#a6.

  8. Leconte I, Thierry C, Bongiorno A, Luyckx M, Fellah L. Non-puerperal uterine inversion. J Belg Soc Radiol. 2016;100(1):47. https://doi.org/10.5334/jbr-btr.974

  9. ATLS Subcommittee, American College of Surgeons' Committee on Trauma, International ATLS working group, Chapleau W, Al-khatib J, Haskin D, et al. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363-6. https://doi.org/10.1097/TA.0b013e31828b82f5

  10. Chang R, Holcomb JB. Optimal fluid therapy for traumatic hemorrhagic shock. Crit Care Clin. 2017;33(1):15-36. https://doi.org/10.1016/j.ccc.2016.08.007

  11. Bhalla R, Wuntakal R, Odejinmi F, Khan RU. Acute inversion of the uterus. Obstet Gynaecol. 2009;11(1):13-8. https://doi.org/10.1576/toag.

  12. Ida A, Ito K, Kubota Y, Nosaka M, Kato H, Tsuji Y. Successful reduction of acute puerperal uterine inversion with the use of a bakri postpartum balloon, Case Rep Obstet Gynecol. 2015;2015:424891. https://doi.org/10.1155/2015/424891

  13. Antonelli E, Irion O, Tolck P, Morales M. Subacute uterine inversion: description of a novel replacement technique using the obstetric ventouse. BJOG. 2006;113(7):846-7. https://doi.org/10.1111/j.1471-0528.2006.00965.x

  14. World Health Organization. WHO recommendations for prevention and treatment of maternal peripartum infections [Internet]. Geneva: World Health Organization; 2015 [cited 2019 Dec 7]. Available from: https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/peripartum-infections-guidelines/en/.

  15. Zhang Y, Yan J, Han Q, Yang T, Cai L, Fu Y, et al. Emergency obstetric hysterectomy for life-threatening postpartum hemorrhage: a 12-year review. Medicine (Baltimore). 2017;96(45):e8443. https://doi.org/10.1097/MD.0000000000008443

How to Cite
Wahono WT, Putri A, Saroyo YB, Nugroho AJ, Sally R, Simanjuntak SP, Samuel. A case of third degree hemorrhagic shock due to total subacute uterine inversion after delivery. Med J Indones [Internet]. 2021Feb.11 [cited 2024May19];30(1):71–4. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/3862
Case Report/Series