n Obstetrics and Gynaecology Forum - Postpartum haemorrhage following manual removal of retained placenta from an inverted uterus and the role of mersilene tape : lessons to learn : review

Volume 24, Issue 3
  • ISSN : 1027-9148



Acute uterine inversion (AUI) is a rare obstetric emergency. Manual removal of placenta in such circumstances often leads to massive postpartum haemorrhage (PPH) if the procedure is performed before correction of the inversion. In the case reported, a 20 year old G3, P1+1 at term, had a spontaneous vaginal delivery in a district hospital. During the third stage of labour, she developed AUI with the placenta still attached to the uterus. An attending medical officer removed the placenta manually before attempting reduction of the inversion. A massive PPH and shock developed. The medical doctor phoned the referral centre to transfer the patient but the obstetrician receiving the phone call advised that the patient should be taken for an emergency laparotomy at the same district hospital so as to reduce the inversion and possibly apply a uterine tourniquet to manage ongoing PPH. At laparotomy, the inversion was corrected and uterine compression sutures using mersilene tapes were applied. The patient was subsequently transferred to the referral centre. The lessons to be discussed in this case are: manual removal of placenta prior to repositioning of an inverted uterus; treatment options for AUI at a district hospital; and the use of uterine compression suture for the prevention of recurrent AUI.

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