Puerperal uterine inversion- mismanaged third stage of labour: A diagnostic challenge

Abstract

Puerperal inversion of uterus is a catastrophic and a rare complication, which occurs during the third stage of labour. It can lead to severe haemorrhage and shock which results in maternal morbidity and mortality. When diagnosed correctly, early cases can be managed by manual reposition, but neglected and late cases need surgery. With advancement in management of the third stage of labour by oxytocics, the incidence of this entity is decreasing. But in developing countries, delivery by untrained birth attendants with inadequate knowledge in management of delivery and delay in referral to higher centres are leading to a relative increase in uterine inversion cases, which leads to an increase in maternal morbidity and mortality. We are presenting a neglected case of subacute uterine inversion in a home delivered female patient bought with clinical presentation of postpartum haemorrhage, shock with acute kidney injury, and sepsis. Diagnosis was a challenge to the treating gynaecologist because of the dramatic presentation in which she was bought with history of normal delivery 2 days back. This case report is to re-emphasis the need for safe motherhood and delivery, which is still a far cry for many patients. She was resuscitated initially and diagnosed as uterine inversion, and surgical management was required for repositioning of the uterus.