Uterine inversion due to a leiomyoma on postpartum day 41: A case report
Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.Journal of Obstetrics and Gynaecology Research (Impact Factor: 0.93). 07/2011; 37(7):897-900. DOI: 10.1111/j.1447-0756.2010.01420.x
Uterine leiomyomas are common tumors in women of reproductive age and are frequently detected during pregnancy. The major complications during pregnancy include abortion, preterm delivery, abruptio placentae, intrauterine growth retardation, dystocia, and postpartum hemorrhage. Little attention is given to uterine leiomyomas postpartum compared to leiomyomas prior to childbirth. In the present case, a 27-year-old woman, gravida 1 para 1, presented with massive vaginal bleeding, urinary retention and lower abdominal pain on postpartum day 41. She was diagnosed with uterine inversion due to leiomyoma. After a vaginal myomectomy, the uterus was re-placed with a combined vaginal and abdominal approach. Because of timely medical intervention, the patient managed to overcome the crisis and her reproductive organs were successfully preserved.
Article: Acute puerperal uterine inversion
- [Show abstract] [Hide abstract]
ABSTRACT: Background. Uterine inversion is a rare, but life threatening, obstetrical emergency which occurs when the uterine fundus collapses into the endometrial cavity. Various conservative and surgical therapies have been outlined in the literature for the management of uterine inversions. Case. We present a case of a chronic, recurrent uterine inversion, which was diagnosed following spontaneous vaginal delivery and recurred seven weeks later. The uterine inversion was likely due to a leiomyoma. This late-presenting, chronic, recurring uterine inversion was treated with a vaginal hysterectomy. Conclusion. Uterine inversions can occur in both acute and chronic phases. Persistent vaginal bleeding with the appearance of a prolapsing fibroid should prompt further investigation for uterine inversion and may require surgical therapy. A vaginal hysterectomy may be an appropriate management option in select populations and may be considered in women who do not desire to maintain reproductive function.
- [Show abstract] [Hide abstract]
ABSTRACT: Objective: To describe (1) sensitivity/specificity of physical examination to correctly diagnose a prolapsed vaginal mass as benign, (2) success rate for transvaginal myomectomy, (3) risk of associated malignancy. Design: A retrospective cohort study. Materials and Methods: Consecutive patients evaluated at the LAC+USC Medical Center from March 2007 to June 2012 with a diagnosis, including prolapsed leiomyoma, were reviewed. Medical records were reviewed for demographic information, clinical findings, histology reports, and clinical outcomes. Results: Two hundred twenty-six cases were identified. Mean age was 44.2 (±9.1) years and 83.6% of cases were premenopausal. The most common symptom was bleeding (79.2%); 15% of the women were asymptomatic. Most were successfully treated with transvaginal myomectomy, although 14 (6.2%) required urgent hysterectomy. There were no cases of uterine infection before intervention; delay of treatment resulted in acute bleeding in 2 of 18 women. Subsequent hysterectomy was performed in 10.9% of women and was more common in women with additional leiomyomata, compared to those without (24.6% vs. 3.4%, p=0.004). The positive predictive value of examination to predict malignancy was 21.4%. The sensitivity and specificity of examination to detect malignancy were 42.8% and 95.0%, respectively. Concomitant endometrial hyperplasia or cancer was found in 4.2% of women sampled. Conclusions: The sensitivity of physical examination to exclude malignancy in prolapsing lesions is poor. Delayed management of prolapsed leiomyomata appears safe, but carries some risk of bleeding. The preferred treatment is transvaginal myomectomy, avoiding further surgery in 89.1% of women. Concomitant endometrial sampling should be considered to evaluate for endometrial hyperplasia or malignancy. (J GYNECOL SURG 31:205)
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.