ACUTE UTERINE INVERSION(AUI) - STILL PREVELANT IN TODAY'S MODERN PRACTICE INSPITE OF WIDESPREADD BEmOC TRAININGS

Abstract

Introduction: In spite of BASIC EMERGENCY OBSTETRIC CARE(BEmOC)Trainings and Services rate of AUI  in the country is  seemingly high especially in the peripheries. AUI  is an unpredictable entity where in hemorrhage can be life threatening requiring prompt recognition and aggressive management. This study is a retrospective analysis of the admissions at a tertiary care centre over 3 years with AUI.  

Materials and Methods This is a rural based retrospective study carried out in a tertiary care centre involving study of maternal outcome and complications in patients of AUI. All patients admitted in the tertiary care centre with AUI from August 2013 to August 2015 were included.All 10 cases of AUI  were referred cases out of which  6 were from private hospitals and 4 from government centres mainly due to improper management of third stage of labour . 50 % females were Primipara  ,50% presented with hemorrhagic shock and 10 %  adherent placenta. Almost all were  managed successfully by Manual reposition technique and only 3 required Hydrostatic method  .All required ICU stay due to hemorrhagic and neurogenic shock and critical condition. Three required DUBT and one  ended up in a  Laparotomy. 

Conclusion  AUI  is a preventable obstetric complication .Active management of third stage of labour is the key to prevent such complications and the following morbidity and mortality .It is time we check our training programs and reinforce the field staff with ongoing supervised monitoring after the training program. Since  all cases presented with hemorrhagic shock a multidisciplinary approach for resuscitation is the key to the management .Early and timely management at a tertiary care centre has shown to reduce the mortality rate considerably.