Acute puerperal uterine inversion as a cause of postpartum hemorrhage treated at the Huaral Hospital

Abstract

A clinical case of acute postpartum uterine inversion as the cause of postpartum hemorrhage treated at the Huaral Hospital. This is an observational, descriptive, retrospective study of a clinical history review of a pregnant woman whose delivery was complicated by acute uterine inversion, leading to postpartum hemorrhage. The patient was a second-time pregnant woman at 37 weeks, with a diagnosis of premature rupture of membranes and a history of preterm delivery three years prior, resulting in fetal death at 27 weeks. In the current pregnancy, she had a vaginal delivery, with a male newborn, Apgar score of 8 at one minute and 9 at five minutes, weighing 2980 grams, and clear amniotic fluid. During the delivery of the placenta, resistance was noted, and controlled suprapubic pressure and traction of the umbilical cord were applied. Uterine inversion occurred, leading to massive hemorrhage and hypovolemic shock. Immediate attempts at uterine repositioning were unsuccessful, and because of strongly adhered placental remnants, an exploratory laparotomy was performed to restore the uterus, and Landaure sutures were applied. The patient’s condition worsened, and a total hysterectomy with right oophorectomy was performed. In the intensive care unit, disseminated intravascular coagulation and renal failure were detected, leading to her referral to a third-level hospital.

Se presenta un trabajo académico que expone el caso de una multigesta de 19 semanas con hipertensión arterial crónica no controlada, edad materna avanzada, hipotiroidismo y complicada con muerte fetal, inicialmente atendida por emergencia en el Centro Materno Infantil Perú Corea (I-4) donde es referida al Hospital Nacional Daniel Alcides Carrión (III-1) atendida y controlada la presión es dada de alta, con indicación de iniciar atenciones prenatales por consultorio externo. Días después, la paciente es atendida en el puesto de salud Bahía Blanca (I-2) por una crisis hipertensiva siendo trasladada de emergencia al hospital local de Ventanilla (II-1) y tras ser evaluada es nuevamente referida al Hospital Nacional Daniel Alcides Carrión, dónde requirió hospitalización en Unidad de Cuidados Intensivos y manejo multidisciplinario por las complicaciones que se presentaron producto del cuadro hipertensivo.