Anyone else w/a completly inverted uterus immediately after birth? Updates in #19! - Mothering Forums
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#1 of 25 Old 12-31-2007, 08:26 PM - Thread Starter
 
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Hi mamas,
I'm starting to think about having another LO but need to get some more information before I'm ready to move forward. I had a fully inverted (spontaneous) uterus immediately after the delivery of my daughter and have a huge number of fears about the possiblity of it occuring again. There appears to be no medical reason why it occured, I'm very healthy, had a relatively normal pregnancy, a normal sized dd, and an unmedicated vaginal delivery (except the 3 doses of cytotec they needed to get my labor started due to low ammniotic fluid). I had a midwife present at the delivery but fortunately for me, I delivered in a hospital because the services of an anestesiologist and OB were required to re-invert my uterus and stop the bleeding. The OB estimates I lost 2 1/2 liters of blood and obviously needed several blood transfusions over the following few days. Since there is no medical reason why my inversion occured, they are unable to determine with certainty whether or not it will happen again. It is such a rare occurance that the midwives and OBs do not "think" it will happen again but they don't "know." It scares the he** out of me because I was pretty close to bleeding to death the first time and sometimes wonder if it is worth it to try another birth.

I'm am a huge proponent of natural childbirth (I'm actually working on my CNM now) and always planned vaginal, unmedicated deliveries. One option for me is to just have a planned c-section but even that isn't a 100% guarantee that my uterus won't invert. Any future deliveries must occur at a hospital and would unfortunately be very closely monitored by an OB and anesthesiologist as another inversion may result in me needing a emmergent hysterectomy.

So if you are still reading, thank you! And if you have any advise or stories to share with me about your experiences with inverted (not prolapsed, it is different) uterues, I would really appreciate it!
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#2 of 25 Old 12-31-2007, 08:41 PM
 
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I don't know enough about the condition, but I would wonder if the cytotec didn't play a part.



-Angela
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#3 of 25 Old 12-31-2007, 10:47 PM
 
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I'm sorry that happened to you
It is very rare, and in 17 years of doing OB/GYN I have only seen it a few times, and only in grand multips. It's a true emergency and I understand why you would have concerns about the next delivery.
I'm sorry I don't have more advice for you. Good luck with your decision.
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#4 of 25 Old 01-02-2008, 12:09 AM
 
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Just to be clear: I have never had an inverted uterus.

But I just wanted to mention that my doctor told me not to push during delivery of the placenta, as this could cause an inverted uterus. I was having a natural urge to push to deliver the placenta. As I said, "I have to push!", he said, "Don't! Your uterus could turn inside out!" This was my second birth and at that point, I had never heard of inverted uteruses. His warning scared me out of my wits and completely wiped out any pushing urge for a second or two, then the placenta plopped out into the bowl.

I thought his warning was so strange. Why would a natural cue from one's body to deliver the placenta possibly result in the uterus turning inside out? I did a little big of digging after that. I read that inverted uterus can be caused by active management of the third stage (ie. use of pitocin and cord traction). The cord traction, in particular, made sense to me.
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#5 of 25 Old 01-02-2008, 02:36 AM - Thread Starter
 
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Thank you ladies for your kind thoughts and suggestions! I struggled with some severe PTSD for about a year and it is starting to resurge a little as we are discussing another pregnancy. I think the most difficult part is that there is absolutely no reason anyone can give me as a definite cause of why this happened and very litte information available online or from my doctors. My doula thinks it was the cytotec too but the OBs that are now involved say "no way." I was fortunate to have delivered with a midwife who does not practice active 3rd stage management so there was no traction on the cord, it just came out attached to my placenta. I will continue on my quest to find an answer and am going to start another thread for suggestions on improving my uterine health/stregnth in advance of another pregnancy. I probably have 9 months before I can concieve so I would like to do everything I can to reduce the likelihood of another inversion.
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#6 of 25 Old 01-02-2008, 12:59 PM
 
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not a bp- but my first thought was the cytotec, and then did they pull the cord at all? i now you said it came out attached to the placenta but that doesnt mean noone yanked by the way you said it.
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#7 of 25 Old 01-02-2008, 02:27 PM
 
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Originally Posted by meganne79 View Post
Thank you ladies for your kind thoughts and suggestions! I struggled with some severe PTSD for about a year and it is starting to resurge a little as we are discussing another pregnancy.
Sorry you had to go thru that. I bet it was awful.
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I think the most difficult part is that there is absolutely no reason anyone can give me as a definite cause of why this happened and very litte information available online or from my doctors. My doula thinks it was the cytotec too but the OBs that are now involved say "no way."
You don't really think the docs would admit guilt, do you? Active third stage management is one of the leading causes of inversion and I think it happens far more often than most people realise. The staff aren't genrally allowed to talk about it unless the client notices it(i.e, if she had an epidural and didn't feel it)You are a nurse, read Anne Frye's books, and you will be amazed at the number of interferences that can cause these complications. Most of what is seen at a hospital is rarely seen at homebirths. Also Henci Goer's Obstetric Myths vx. Research Realities is a real eye opener.
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I was fortunate to have delivered with a midwife who does not practice active 3rd stage management so there was no traction on the cord, it just came out attached to my placenta.
The cord *should* be attached to the placenta, but I would bet money the cytotec caused the inversion. It can also cause uterine rupture and dehiesance in a woman who has never had uterine surgery...
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I will continue on my quest to find an answer and am going to start another thread for suggestions on improving my uterine health/stregnth in advance of another pregnancy. I probably have 9 months before I can concieve so I would like to do everything I can to reduce the likelihood of another inversion.
Bless your heart for wanting to try again! But I would strongly advocate not birthing in a hospital under these circumstances- you will be much safer at home, especially since you *are* a nurse....
PS, I was in nursing school and changed majors when i found out we wouldn't be allowed to help the laboring moms when we did our OB rotations- I was a late bloomer for school, and was 42 and already had 17 years in as a doula and a few homebirths by the time I started. Our hospitals were guinea pig stations there.... Decided to finish up in Computers and then get my CPM....Best of luck with the rest of your schooling...
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#8 of 25 Old 01-02-2008, 03:48 PM
 
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One word: cytotec

and few are the OBs who would admit to that. They use it themselves and MUST beleive it is safe enough. And besides, if they tell you now that it coulda been the cytotec, then they have just signed up to testify in your malpractice suit against your former HCP (at least, so they will imagine).
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#9 of 25 Old 01-02-2008, 11:16 PM
 
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Oh Megan, that's really horrible!
I want to believe it was the cytotec, but who knows? So I assume by your post that there was definately no accreta? I don't know why it seems that birth is extra hard on midwives! I guess to make us more aware and compassionate. Although it stinks that you will have to have your next baby in the setting you described, everything will be ready for you if you need it. And while its ashame to lose that ideal dream birth, having a baby is really the reason we go through it all. I wish you lots of luck.

Wife to Joe and Mama to Rosie, 6/28/06, Jack, 10/25/08 and JoJo 3/18/10.
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#10 of 25 Old 01-03-2008, 12:22 AM - Thread Starter
 
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Thank you guys again! It is really nice to actually find people willing and knowldegable enough about this to talk with. I wish I had found this board sooner.

One clarification, I think my second post was a little confusing, I meant that my uterus came out attached to the placenta, not the cord attached to the placenta. Oops!

Also, a little bit more information, maybe you wonderful ladies can use to provide more insight - I'm just loving having someone to discuss this with!!! There definitly did not appear to be any accreta. They did check that prior to dd's birth and everything appeared fine.
My pregnancy was perfectly healthy and easy except at 37 weeks I was diagnosed with low fluid levels (10cm I think) and my placenta was graded a 3at that time. My fluid levels rebounded to just over 12 and then at 40 weeks I was down to 5cm and dd was sluggish so they decided they needed to induce.
As far as L&D, the 1st cyto. didn't work, neither did the pit. so 2 more doeses of cyto later I went from virtually no contractions to extrememly intense ones. There was virtually no build up, just BAM!
Like I said, to my knowledge (which is of course limited to what I was told by the bps) there was no traction applied to the cord.
I had to be given nitro to drop my pressure enough to reinvert my uterus.
The crazy thing is that I (stupidly) and the doctors assumed I would not have any lasting implications from the inversion??? But I bled for 5 MONTHS. Test after test, methergine, and something else (I forget what) failed to stop the bleeding so it was just decided that we would "wait and see when it stops" because I was tired of being regularly violated and filling my body with nasty drugs. 5 months later it finally did.
I now have horrible periods lasting anywhere from 7 to 14 days, only 23 to 28 days apart, super heavy bleeding, and lots of cramping.
What does all that craziness say to you guys?

I do really want another one and would really like to try, I just am scared to death to leave my kids motherless (I know it sounds overly dramatic but it does feel that way sometimes!). I feel like I need to empower myself to do everything I can to avoid a recurrance and improve the stregnth of my uterus.

Thank you again ladies and blessings to all of you!
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#11 of 25 Old 01-03-2008, 03:47 AM
 
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wow, that is some craziness. I have never had an inverted uterus. I am very sorry that happened to you!

have you considered trying some Red Rasberry leaf now, before you TTC? It's a uterine tonic, surely it can't hurt and might do you a lot of good. I'd be downing the stuff if I were in your shoes. Your AF issues say to me that your body is still very affected by what happened. Do you notice any improvements as time passes, any signs of things returning to normal slowly in your cycle? How long has it been since your inversion? It might be a good idea to wait(you have said you are, I know) to see if things started going back to normal before setting a date to TTC. You want to make sure your uterus is 100% before asking it to carry a baby again. It seems to me that the way our cycles behave is a good indicator of our reproductive health.

And yeah with the pp about the cytotech. If it can weaken a non-scarred uterus enough to cause it to rupture, you can't discount it as a cause of your inversion. Have you considered contacting a doctor who acknowledges the risks of cytotech to ask about your experience. You could write a letter to someone like Marsden Wagner, I bet he or someone like he would be interested in speaking with you.

BTW- i don't think you are being overly dramatic at all.

Banana, doula wife to Papa Banana and mother to Banana One, Banana Two, Banana Three, Banana Four...

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#12 of 25 Old 01-03-2008, 12:31 PM - Thread Starter
 
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have you considered trying some Red Rasberry leaf now, before you TTC? It's a uterine tonic, surely it can't hurt and might do you a lot of good. I'd be downing the stuff if I were in your shoes. Your AF issues say to me that your body is still very affected by what happened. Do you notice any improvements as time passes, any signs of things returning to normal slowly in your cycle? How long has it been since your inversion? It might be a good idea to wait(you have said you are, I know) to see if things started going back to normal before setting a date to TTC. You want to make sure your uterus is 100% before asking it to carry a baby again. It seems to me that the way our cycles behave is a good indicator of our reproductive health.

And yeah with the pp about the cytotech. If it can weaken a non-scarred uterus enough to cause it to rupture, you can't discount it as a cause of your inversion. Have you considered contacting a doctor who acknowledges the risks of cytotech to ask about your experience. You could write a letter to someone like Marsden Wagner, I bet he or someone like he would be interested in speaking with you.

BTW- i don't think you are being overly dramatic at all.
I will definitely start on the RRLT right now! I'm happy to take that. I think I'm going to try to start some Mayan massage too. As far as my cycle slowly returning to normal, it seems to a little closer to normal (still not nearly normal) for a cycle or two and then I have a crazy 13 day period or some other problem. My inversion was 22 months ago.

I love your idea about contacting another doctor who would look at the situation from a non-traditional medical standpoint but don't really know how to go about finding one. Who is Marsden Wagner? I live in the Denver area and we aren't known for being very progressive in the birthing arena. Maybe if I email Dr. Wagner he would know of someone locally to speak with. The only thing I'm not really interested in is more testing. I know it may be necessary but I've had more tests and drugs related to this than I have with anything else in my life. Yuck!
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#13 of 25 Old 01-03-2008, 03:20 PM
 
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Have you had your blood work done? I wonder what your hormone levels look like, and if you are anemic. I've been thinking of you a lot since I read your post and I wonder if maybe you had an extra sticky placenta combined with a uterus compromised by multiple doses of cytotec. It seems possible that a hormonal imbalance previous to your last pregnancy caused less than optimal placental developement. This could explain decline in placenta function at 37 weeks, and may explain why the placenta would adhere to the uterus enough to cause inversion. It could also explain why your cycle is so messed up right now. If you haven't already, I would try all of the natural ways to balance my cycle: accupuncture, chinese herbs, vitex, progesterone cream, etc. I would also check my progesterone level as soon as I found out I was pregnant and consider supplementation if it was on the low side. I guess that's enough rambling from me!

Wife to Joe and Mama to Rosie, 6/28/06, Jack, 10/25/08 and JoJo 3/18/10.
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#14 of 25 Old 01-03-2008, 03:22 PM
 
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Oh, and hats off to you for being able to breastfeed through all of that! (I just read your sig line)

Wife to Joe and Mama to Rosie, 6/28/06, Jack, 10/25/08 and JoJo 3/18/10.
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#15 of 25 Old 01-03-2008, 05:07 PM
 
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Originally Posted by alegna View Post
I don't know enough about the condition, but I would wonder if the cytotec didn't play a part.



-Angela
Cytotec does not cause every single bad outcome in the universe. What exactly would be
the mechanism for that? Uterine rupture and uterine inversion are very different things.
Just because they both happen to a uterus doesn't make them related.

If anything, I would expect miso to be preventative, since it encourages uterine contraction and one issue with inversion is that the uterus is not contracted sufficiently. Obviously, though, it's very unlikely miso was at all related, since it has a 4-hour half life and would almost certainly be completely cleared by the time of birth.

Pub Med search turned up only references for using miso for PPH following a uterine inversion -- for which it's recommended by the authors.

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#16 of 25 Old 01-04-2008, 02:27 AM
 
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Who is Marsden Wagner? I live in the Denver area and we aren't known for being very progressive in the birthing arena. Maybe if I email Dr. Wagner he would know of someone locally to speak with.

he is an well known ob/perinatoligist and researcher, who is very outspoken in his criticism of american maternity care, and very anti-cytotech. i think that is a great idea, he may know if there are cases of inversion related to cytotech. or may have some names for you. good luck!

Banana, doula wife to Papa Banana and mother to Banana One, Banana Two, Banana Three, Banana Four...

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#17 of 25 Old 01-04-2008, 01:10 PM
 
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I can't understand why cytotec would cause an inversion.

What a horribly scary thing for you to experience!. I have never seen an inversion, and I hope I never will.

I wonder if it would help you to contact a physical therapist who specializes in women's health and pelvic floor issues. Perhaps strengthening your lower abdomen and pelvic floor will help prevent (or at least in some manner minimize) the risk of a recurrance. I've seen this sort of therapy recommended for those who have prolapses, so why not for a woman with a history of inversion?

Good luck in your search for information. Let us know what else you discover.
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#18 of 25 Old 01-04-2008, 02:50 PM
 
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Originally Posted by cathicog View Post
The cord *should* be attached to the placenta, but I would bet money the cytotec caused the inversion. It can also cause uterine rupture and dehiesance in a woman who has never had uterine surgery...
Just to clarify, it's impossible to have a uterine dehiscence in the absence of a uterine scar -- a dehiscence by definition is the disruption of a scar. Uterine rupture of an intact uterus is, of course, still a possibility, whether or not miso is used.

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#19 of 25 Old 01-04-2008, 09:20 PM - Thread Starter
 
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Ok ladies! Thank you thank you again! I really can't tell you how wonderful it is to have people to talk about this with! I have a little bit more info. and a couple more questions.

I traded emails with Marsden Warren and his thought is that it was absolutely the Cytotec (his thought is that the severe contractions caused by the cytotec and the changes it makes to the uterine wall can cause inversion). I would imagine there are lots of factors that played a part but it is interesting to actually have an OB say it was the cytotec. I knew going into my delivery that there was a great deal of dissention about the use of cytotec in inductions and now have some feelings I need to work on because I was adamant that I not be given it but relented after a lot of pressure from the midwife who started my induction. Also, the response from him (which I have asked for clairfication on) makes me think that he does not feel it would be safe for me to try to have another pregnancy. He thought that maybe in a few years I MAY be able to get pregnant and I MAY be able to maintain a healthy pregnancy. So my question for you is, what do you think? Do you (or do you know of people) think pregnancy (at least 2 1/2 years) after an inversion is safe? What would you do as mothers and bps? How do you think I would know if it was safe?

I'm generally not a fan of the typical medical "establishment" (despite going to work in it when I'm done with school - hey, that way I can work on change!) but would be more than willing to go in and see someone like a high-risk OB if that would get me anywhere. What do you think? Is it worth talking with someone locally?

to all of you awsome women!
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#20 of 25 Old 01-04-2008, 09:24 PM - Thread Starter
 
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Have you had your blood work done? I wonder what your hormone levels look like, and if you are anemic. I've been thinking of you a lot since I read your post and I wonder if maybe you had an extra sticky placenta combined with a uterus compromised by multiple doses of cytotec. It seems possible that a hormonal imbalance previous to your last pregnancy caused less than optimal placental developement. This could explain decline in placenta function at 37 weeks, and may explain why the placenta would adhere to the uterus enough to cause inversion. It could also explain why your cycle is so messed up right now. If you haven't already, I would try all of the natural ways to balance my cycle: accupuncture, chinese herbs, vitex, progesterone cream, etc. I would also check my progesterone level as soon as I found out I was pregnant and consider supplementation if it was on the low side. I guess that's enough rambling from me!
I haven't had my blood done (at least that I know of) to check hormones. I amazingly wasn't anemic when that was tested 3 months post-partum. That would be worth checking into. I think I need to get a copy of my medical records and start doing some more "medical" research.

Thanks for the comment on my still breastfeeding too. That is still going strong
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#21 of 25 Old 01-04-2008, 09:26 PM - Thread Starter
 
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I wonder if it would help you to contact a physical therapist who specializes in women's health and pelvic floor issues. Perhaps strengthening your lower abdomen and pelvic floor will help prevent (or at least in some manner minimize) the risk of a recurrance. I've seen this sort of therapy recommended for those who have prolapses, so why not for a woman with a history of inversion?

Good luck in your search for information. Let us know what else you discover.
That is a good idea! I will look into that along with Mayan massage. If it all works I may have the strongest uterus out there!
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#22 of 25 Old 01-04-2008, 11:48 PM
 
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there are things I would recommend that you do- go to the hospital and get a copy of your records- not just the little "surgical" note that your doc keeps but the bigger record at the hospital- and read though them carefully- also I would say go to a doc now, not the OB or one associated with the practice you went to for the birth-- you want a pre-pregnancy work-up including ultrasound to rule out a fibroid or any other mass-- I am wondering what happened post partum with the bleeding-- there are rare cases but cases still of a mass continuing to cause degrees of inversion (not necessarily complete)and increasing postpartum bleeding.
-----
it could be as simple as pulling on the cord--and inverting the uterus- I will look further at the info on cytotec- but it was in my suspicion range as well because it can cause uterine ruture, and thinning of the uterine wall and weaking of the fundus could cause an inversion or contribute to it
-- I also have controlled a hemorrhage where the placenta was partially attached and the uterus was still in pushing mode so the fundus was pushing down and the cervix opened fully during a contraction the cervix would close down some between contractions it wouldn't have took much for that uterus to become inverted during a contraction I am sure an unguarded tug on the cord could have done so--(after manually removing the placenta I held the cervix shut and the fundus)

in any case here is an abstract---


Trop Doct. 2007 Oct;37(4):256-7.

Clinical profile of patients presenting with uterus inversion.

Taneja A, Puri M, Sagartrivedi S.

Department of Obstetrics and Gynaecology, Lady Hardinge Medical College and Associated Hospitals, New Delhi 110001, India. anjalidoc@hotmail.com

Inversion uterus is an unusual complication of vaginal delivery. Mismanaged third stage of labor is the most commonly identified predisposing risk factor. The condition requires immediate intervention. This retrospective study was conducted in Lady Hardinge Medical College and Associated Hospitals, New Delhi, India with the aim to study the clinical profile and outcome of patients admitted with inversion uterus. A total of six cases of inversion uterus were managed during the five year period reviewed. All patients had acute inversion and were managed successfully by manual reposition except one with chronic inversion which required laparotomy. In this case Huntington's technique was used to reposit back uterus. The patients were discharged in satisfactory condition with a mean hospital stay of nine days. Early diagnosis, resuscitation and replacement of inverted uterus are essential components of management of this rare but life threatening situation. Proper management of third stage is recommended.

PMID: 17988503 [PubMed - indexed for MEDLINE]
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#23 of 25 Old 01-05-2008, 12:19 AM
 
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I have never had a client have an inverted uterus myself. I have attended a birth for a woman who had an inversion with her first delivery. Her records, when I obtained them were pretty scant, but it looked like the inversion was caused by cord traction just reading the sequence of events. Her uterus could not be manually replaced and she had emergency surgery in which they made an abdominal incision and then pushed the uterus back up manually, grabbing it from inside the abdomen as near as I can tell. She required a lot of blood during and after surgery and had a really rough recovery.

During her second pregnancy I consulted a perinatologist who just suggested I not touch the cord and have anesthesiology ready to go if necessary. I absolutely held my breath the whole time, but she had a normal, unmedicated second birth, and delivered the placenta spontaneous about 10 minutes later. Anesthesia and an OB back up waited in the hall for me, but there were no problems or complications at all.

Did they send the placenta to pathology at all? I would wonder about a partial accreta. That can only be diagnosed by pathology. If the placenta was too attached to the uterus, inversion might have been more likely. The prolonged bleeding afterwards can be seen with accreta as well. Also, induction of labor is a well known risk for postpartum hemorrhage, as is long labor, usually because the uterus doesn't contract well after birth. I can imagine that if the uterus was really poorly contracted after birth an inversion would be more likely.
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#24 of 25 Old 01-05-2008, 12:51 AM - Thread Starter
 
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Originally Posted by doctorjen View Post
I have never had a client have an inverted uterus myself. I have attended a birth for a woman who had an inversion with her first delivery. Her records, when I obtained them were pretty scant, but it looked like the inversion was caused by cord traction just reading the sequence of events. Her uterus could not be manually replaced and she had emergency surgery in which they made an abdominal incision and then pushed the uterus back up manually, grabbing it from inside the abdomen as near as I can tell. She required a lot of blood during and after surgery and had a really rough recovery.

During her second pregnancy I consulted a perinatologist who just suggested I not touch the cord and have anesthesiology ready to go if necessary. I absolutely held my breath the whole time, but she had a normal, unmedicated second birth, and delivered the placenta spontaneous about 10 minutes later. Anesthesia and an OB back up waited in the hall for me, but there were no problems or complications at all.

Did they send the placenta to pathology at all? I would wonder about a partial accreta. That can only be diagnosed by pathology. If the placenta was too attached to the uterus, inversion might have been more likely. The prolonged bleeding afterwards can be seen with accreta as well. Also, induction of labor is a well known risk for postpartum hemorrhage, as is long labor, usually because the uterus doesn't contract well after birth. I can imagine that if the uterus was really poorly contracted after birth an inversion would be more likely.
Thank you so much for the positive story of a sucessful delivery post inversion! I want to have several more little ones and it aboslutely breaks my heart to think I might not be able to. I definitely needed to hear a positive outcome!

As far as the placenta and pathology, I don't know. I'm ordering a full copy of my records from both the OB office and the hospital so I can read what they actually say. Do you know if the patho. report would be in there too if there is one? I know they checked for an accreta during routine ultrasounds but perhaps it wasn't visible. It does sound like there was a problem with my placenta since it was already a "grade 3" at 37 weeks. I actually examined it a little once I was coherent again and it had quite a bit of calcification on it. Obviously I feel a little desperate to find some answers! I hate to think my midwife may have caused it with too much traction, or that the cytotec I really didn't want to have in the first place may have done it. It would be a lot easier if I were able to find that it was an accreta or hormonal or something like that. Though the MW or cyto. are obviously easy to control in subsequent pregnancies.
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#25 of 25 Old 01-29-2014, 10:11 AM
 
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Hey there!!! Your story is very similar to mine, except I was never brave enough to try again. I had no help after leaving hospital, even after I became very depressed. Ten years later, I still struggle with the fact that intervention may have prevented me completing my family. And I worry the same could happen to my daughters. That said, I am glad to be alive and watching them grow up!! Good luck to you, and thanks for writing about your experiences, as I have never been able to share mine with anyone who understands xx
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