Uterine inversion is a condition when the uterus is partially or completely inverted. The incidence of uterine inversion varies from one in 2000 to 20,000 deliveries. Uterine inversion can lead to death. Hypovolemic shock, as well as neurogenic shock, may occur, with complications of severe hypotension, bradycardia, and cardiac arrest that begin in a short time and must be treated immediately. The survival rate is average 86%. Many risk factors for uterine inversion such as placental fundal attachment, fundal leiomyoma, control of umbilical cord traction before signs of placental separation, uterine atony, and abnormally attached placenta to the uterine wall. In most cases, no risk factors are identified, so the condition is unpredictable. The treatment provided depends on the individual circumstances and preferences of the hospital staff. Treatment options include uterine repositioning, abdominal surgery, or an emergency hysterectomy. Hysterectomy is the last option in the treatment of uterine inversion that needs to be prevented because it is associated with long-term effects on women’s health. In addition to the reproductive organ system that will change, hysterectomy can be associated with other diseases such as cardiovascular disease. The focus of uterine inversion is to treat bleeding and prevent shock. Condom catheters are easy to find in healthcare facilities. This can be a solution for health facilities in developing countries that do not have the resources or equipment for hysterectomy. We present the successful use of condoms catheter for the treatment of uterine inversion.
Mrs. SIM, a 35-years-old secondary primigravida woman, got regular antenatal care from a midwife’s independent practice. The patient was married and had given birth three times, including the first child aged 18 years, the second child aged 14 years, and the third child aged 3 h. The patient gave birth according to the estimated date. The weight of a newborn baby is 3700 g. The patient had no previous drug allergies. Based on family history, no specific inherited disease was found. The patient did not smoke or drink alcohol or drugs. The patient complained of pain and dizziness. The family accompanied the patient during the treatment process. In the course of his case, the patient was finally successfully treated with a catheter condom to stop the bleeding.
Condom catheters can be helpful in the management of uterine inversion, especially in stopping bleeding, although the main focus of action is on repositioning the uterus. In the initial setting of a patient in hypovolemic shock, the use of a condom catheter after suturing can treat bleeding effectively. Condom tamponade, which was placed and inflated with normal saline, because the patient was not responsive to uterotonics, was found to be effective in stopping bleeding. Condom tamponade saves time and money with positive results in about 96.7% of cases. The device also shortens the hospital stay and avoids the need for surgical management.
The prospect of using a condom catheter in this study needs to be adjusted to the appropriate use technique and the patient’s condition. The normal amount of saline needs to be considered in each case. 350 ml of normal saline is required to produce sufficient tamponade to stop bleeding within 10 min. Another study used Bakri balloons for the management of uterine inversion leading to placenta accreta, and the patient was in shock. The procedure is similar to a condom catheter in that a Bakri balloon is inserted into the uterine cavity under ultrasound guidance and filled with normal saline. Uterine inversion can be successfully treated and the bleeding stopped. Moreover, no reinversion was observed. Bakrie balloons may be a solution but for developing countries, condom catheters can be used as an alternative. This situation is particularly effective when uterotonics are ineffective or unavailable or where access to surgery is not possible.
Author: Eighty Mardiyan Kurniawati
Details of the research can be viewed here:
https://www.sciencedirect.com/science/article/pii/S2210261222003224?via%3Dihub
Eighty Mardiyan Kurniawati, Successful use of condom catheters for management of uterine inversion: Case report and literature review, International Journal of Surgery Case Reports,Volume 94,2022,https://doi.org/10.1016/j.ijscr.2022.107076.
