Uterine inversion

　　Most uterine inversion is due to improper management during the third stage of labor (about 50%), but the prerequisite must be the relaxation of the uterine wall and the dilation of the cervix. The factors that promote uterine inversion include:

　　1. The result of the midwife pulling the placental umbilical cord attached to the fundus of the uterus

　　At this time, if the umbilical cord is tough and does not break from the placenta, and combined with the force of pressing on the relaxed fundus of the uterus, uterine inversion will occur.

　　2. Short umbilical cord or entanglement

　　Overstretching the umbilical cord during the process of fetal delivery can also cause uterine inversion.

　　3. Congenital maldevelopment of the uterus or excessive weakness of the mother

　　During labor, due to coughing or straining during the second stage of labor, increased abdominal pressure can also cause uterine inversion.

　　4. Standing delivery by the mother

　　Uterine inversion is caused by the traction force of the fetus's weight on the placental umbilical cord.

　　5. Use magnesium sulfate to relax the uterus during preeclampsia

　　It can also promote uterine inversion; there are reports that implanted placenta can also promote uterine inversion.

　　The complications of uterine inversion are mainly infection and shock, and the specific complications are described as follows.

　　1. Infection manifestations Infection is common in chronic uterine inversion or after various methods of reduction in acute uterine inversion, which can manifest as local infection of the reproductive system, as well as peritoneal peritonitis or even sepsis.

　　2. Shock Inversion of the uterus can cause shock. The cause and mechanism of shock vary due to the different clinical manifestations of uterine inversion. Severe pain in acute uterine inversion can quickly lead to painful shock after uterine inversion, which occurs relatively early and the degree of vaginal bleeding does not match the degree of shock; if acute uterine inversion combined with postpartum massive hemorrhage is not controlled in time, correcting anemia and improving microcirculation, it can lead to hemorrhagic shock; at the same time, pain and hemorrhage can interact with each other, leading to aggravation of shock. Chronic uterine inversion, due to chronic hemorrhage and exudation, and the occurrence of various serious infections, can lead to infectious shock.

　　Patients with uterine inversion often manifest severe pain, bleeding, difficulty in defecation and urination, and other clinical symptoms and signs are described as follows.

　　Firstly, symptoms

　　1. Medical history and labor management Previous history of uterine inversion, combined with maldevelopment of the uterus such as uterine malformation, twin pregnancy, polyhydramnios, rapid labor, upright labor, short or relatively short umbilical cord, exerting force on the fundus or pulling on the umbilical cord to assist in the delivery of the placenta, etc., understanding the above clinical data is helpful for the diagnosis of uterine inversion.

　　2. Pain manifestations The degree of pain varies. Mild cases may only manifest as postpartum lower abdominal pain or a sense of vaginal distension, while severe cases can cause painful shock. The typical pain of uterine inversion is sudden severe lower abdominal pain after traction of the umbilical cord or pressing on the fundus during the third stage of labor. Pay attention to this pain being persistent, so as to distinguish it from uterine contraction pain.

　　3. Bleeding manifestations The characteristics of bleeding after uterine inversion vary. Chronic uterine inversion patients may only manifest irregular vaginal bleeding or menorrhagia; acute uterine inversion bleeding is related to placental detachment, and those with undetached placenta may not bleed, while those with partial or complete placental detachment may manifest as massive hemorrhage.

　　4. Local compression manifestations In addition to the feeling of pressure in the lower abdomen, patients may experience difficulty in defecation and urination.

　　Secondly, signs

　　1. Abdominal examination In acute uterine inversion, the regular contour of the uterus is usually not palpable in the abdomen, the uterus is significantly lower and wider, and the fundus of the uterus is cup-shaped or stepped; chronic uterine inversion can only manifest as signs of peritonitis.

　　2. Vaginal examination The amount of vaginal bleeding in acute uterine inversion varies; the placenta may be detached or not, and those with undetached placenta are easier to diagnose; those with detached placenta can feel or see a soft spherical object filling the birth canal or protruding from the vaginal orifice. A careful examination of the spherical object will reveal a cervix encircling it or the opening of the fallopian tube, which can confirm the diagnosis. Chronic uterine inversion, in addition to the symptoms of acute uterine inversion, also shows signs of chronic inflammation, such as inflammatory vaginal discharge, ulceration, bleeding, and erosion on the surface of the mass.

　　Uterine inversion is a serious and rare obstetric complication. The main cause of uterine inversion is the forceful traction of the umbilical cord or pressing on the fundus during the placental detachment of the third stage of labor. It is emphasized that proper handling of the third stage of labor is the key to preventing uterine inversion. Once a diagnosis is confirmed, immediate manual reduction should be performed. In cases of shock, uterine reduction should be performed simultaneously with anti-shock treatment, and it is not advisable to wait for the shock to improve before reduction, as this may miss the opportunity for rescue. The specific preventive measures are as follows.

　　Strengthening the training of midwives and properly handling the third stage of labor are important measures to prevent uterine inversion.

　　Do not exert force on the fundus of the uterus or pull on the umbilical cord after the fetus is delivered. While performing artificial placental detachment, it should also be avoided to move the uterine wall.

　　The diagnosis of uterine inversion mainly relies on clinical manifestations and signs, with patients often presenting with severe pain, bleeding, difficulties in defecation and urination, etc. Uterine inversion is mainly diagnosed by ultrasound, which is very meaningful for confirming the condition.

　　Patients with uterine inversion should eat moderate amounts of brown sugar, eggs, etc., and should avoid spicy and warm foods. The specific dietary precautions are as follows.

　　1. What is good for the body if there is an inversion of the uterus

　　1. Millet:Millet is rich in vitamin B1 and vitamin B2, which can help postpartum women recover their strength, stimulate peristalsis, and increase appetite. However, experts remind that millet congee should not be too thin, and it should not be the only food after delivery, as this may lead to a lack of other nutrients.

　　2. Brown sugar:Because brown sugar contains more glucose than white sugar, drinking brown sugar can make the postpartum woman feel warm all over. The high iron content in brown sugar can give the postpartum woman blood, and it contains a variety of trace elements and minerals that can promote diuresis, prevent postpartum urinary incontinence, promote the excretion of lochia, and has the effects of promoting lactation and relieving pain. However, it should not be eaten in excessive amounts either; generally, drinking should not exceed 10 days, as prolonged use can increase bloody lochia, and in summer, it can cause the postpartum woman to sweat more and have less salt in the body.

　　3. Eggs:Eggs are rich in nutrients, with a high protein content, and also contain lecithin, choline, and various vitamins and minerals, which are easy to digest and suitable for postpartum women to eat. However, eating too many is not good. Excessive consumption not only cannot be absorbed by the body but also the cholesterol in eggs can increase blood lipids, and it will also affect normal digestive function, so postpartum women do not need to eat more than 4 to 6 eggs per day.

　　4. Soup:Chicken soup, fish soup, and beef bone soup contain easily absorbable protein, vitamins, and minerals, and are delicious, which can stimulate the secretion of gastric juice, increase appetite, and also promote lactation. Due to the excessive sweating and milk secretion, the water intake of postpartum women needs to be higher than that of the general population, so they should drink more soup. However, experts remind that while drinking more soup, more meat should be eaten, as meat is much more nutritious than soup.

　　What foods should not be eaten if there is an inversion of the uterus

　　1. It is forbidden to eat spicy and warm foods after giving birth

　　Spicy and warm foods include garlic, chili, pepper, fennel, wine, chives, etc. These foods can help generate internal heat, causing postpartum women to have symptoms such as mouth ulcers, constipation, or hemorrhoids. The internal heat in the mother can affect the baby through breast milk, worsening the baby's internal heat.

　　2. It is not advisable to eat too many eggs after giving birth

　　After giving birth, during the postpartum period, it is common for women to replenish their deficiencies with eggs as their main food. However, eating eggs is not the more, the better. It is important to note that within a few hours after delivery, it is best not to eat eggs. Because during the delivery process, there is a significant expenditure of energy, sweating, and a deficiency of body fluids, which also leads to a decrease in digestive ability. If eggs are eaten immediately after delivery, they are difficult to digest and can increase the burden on the gastrointestinal tract. Throughout the postpartum period, pregnant women and postpartum mothers need about 100 grams of protein per day. Therefore, eating 3 to 4 eggs per day is sufficient.

　　3. It is not advisable for postpartum women to drink brown sugar water for a long time

　　During childbirth, the mother expends a lot of energy and blood, and she also needs to breastfeed the baby, requiring abundant carbohydrates and iron. At this time, drinking some brown sugar water, as long as it is in moderation, is beneficial to both the mother and the baby. However, many postpartum women drink brown sugar water for too long, some for half a month, even up to a month. This is not conducive to the recovery of the mother's uterus. The hemostatic effect of brown sugar may also cause continued bleeding in postpartum women. Therefore, the appropriate time for drinking brown sugar water after childbirth is generally 7 to 10 days.

　　4. It is not advisable to eat too much chocolate

　　Eating too much chocolate by postpartum women can affect appetite, interfere with the intake of other foods, leading to a lack of essential nutrients; and it can also affect the health of postpartum women, which is not conducive to the growth and development of infants. The caffeine contained in chocolate can seep into breast milk and accumulate in the baby's body, damaging the nervous system and heart, and causing muscle relaxation, increased urine output, leading to poor digestion, unstable sleep, and constant crying in infants.

　　5. It is not advisable to diet immediately after childbirth

　　Whether during pregnancy or after childbirth, a balanced diet and a reasonable dietary structure are the key to daily eating. After delivery, it is important to ensure that pregnant women and infants have sufficient nutrient intake; otherwise, not only will their own bodies be harmed, but also the newborns may suffer due to insufficient components required for breastfeeding. Doctors suggest that postpartum women should consume calcium-rich foods and absorb at least 11760 kilojoules (2800 calories) of energy per day. After women have finished breastfeeding, they can start to diet moderately, absorbing 6300 kilojoules (1500 calories) per day, plus exercise, to regain a healthy and beautiful figure.

　　6. It is not advisable to drink high-fat thick soups after childbirth

　　Drinking high-fat thick soups often affects appetite and increases the fat content of breast milk, which can have adverse effects on infants. Some newborns cannot tolerate or absorb this high-fat breast milk, which can cause diarrhea. Nutritious meat and vegetable soups, such as egg flower soup, fresh fish soup, tofu soup, vegetable soup, noodle soup, and rice soup, can all meet the needs of both mother and baby for various nutrients.

　　The foundation of treatment for uterine inversion is to discover and diagnose the disease in a timely manner. During the diagnosis and treatment process, patients with uterine inversion often suffer from severe pain, bleeding, infection, and shock, so actively alleviating pain, controlling bleeding, infection, and shock is the prerequisite for treating uterine inversion. After the patient's overall condition is controlled, the treatment measures for uterine inversion include preserving the uterus and removing the uterus, the former including vaginal manual reduction, vaginal hydrostatic reduction, abdominal surgery reduction, and vaginal surgery reduction, and the latter being partial or total hysterectomy via abdominal or vaginal surgery. The choice of measures mainly depends on the patient's overall condition, the time of inversion, the degree of infection, whether there is a desire for childbirth, and whether there are other gynecological tumors. This article briefly introduces several common methods of preserving the uterus for reduction.

　　一、手术治疗

　　Firstly, Surgical Treatment

　　1. Vaginal Manual Reduction

　　(1) Suitable for acute uterine prolapse, where the cervix has not yet retracted and become tight to the prolapsed uterine body.

　　(2) Position the bladder as a stone, and catheterize.

　　(3) If the cervical os is too tight, magnesium sulfate, intravenous injection of diazepam (Valium), intramuscular injection of atropine, intravenous push or sublingual nitroglycerin can be used to relax.

　　(4) If the patient has significant pain, general anesthesia can be used, and the anesthetic time does not need to be too long.

　　(5) Sterile operation, accurate and gentle manual reduction surgery.

　　(6) After reduction, use oxytocin (pitocin), misoprostol, or ergometrine to promote uterine contraction to strengthen the uterine muscle wall tension and prevent recurrence; to prevent recurrence, uterine cavity packing can also be used, but this method increases the risk of infection.

　　(7) Pay attention to bleeding, infection, and other conditions after surgery.

　　(8) During the manual reduction process, the operator's forearm is filled with the vaginal orifice, or the assistant presses the labia minora and labia majora towards the operator's forearm, which helps in the reduction of the uterus, especially in partial uterine prolapse.

　　2. Vaginal Hydropneumatic Reduction

　　(1) Most suitable for partial uterine prolapse. The cup has a diameter of 6 cm, and the cup mouth is placed in the vagina as close as possible to the vaginal wall to prevent water or gas from spilling out; the small hole at the bottom of the cup is connected to a container containing about 2000 ml of normal saline 1 meter above the patient's horizontal level through a thin intravenous infusion tube; the system is open, and normal saline enters the vagina and uterine cavity, and the water pressure in the cavity can help some prolapsed uterus return to its normal position.

　　(3) The rest is the same as manual reduction.

　　3. Abdominal Surgery Reduction

　　Including abdominal traction uterine reduction surgery, abdominal posterior wall uterine incision reduction surgery, and abdominal anterior wall uterine incision reduction surgery, which are also known as Huntington, Haultain, and Dobin surgeries.

　　Secondly, Drug Treatment

　　Antibiotics are used postoperatively to prevent infection.