Inversion of the Uterus

The following case report presents interest from the following view-points. First, inversion of the puerperal uterus is a rare occurrence; second, the case was first seen by the writer in what might be termed a subacute stage; third, the method of treatment differed from the procedures usually recommended as being useful in this condition. That this accident is rare is shown by the fact that Findley4 was able to find records of only 76 cases in the German literature from 1908 to 1929. Beckmann1 records that not a single case occurred in the St. Petersburg Lying-in-Hospital in 250,000 labors, but Haselhorst', on the other hand, cites an incidence of one in 28,000 deliveries in his own clinic. While in many cases the chief etiological factor is apparently violence such as results from the too vigorous employment of Crede's maneuver yet it should be borne in mind that inversion of the uterus may occur spontaneously. Thus in 61 instances of inversion reported by Evans' its occurrence was spontaneous in 18. Findley states that probably one-third of all puerperal inversions occur spontaneously, unassociated with either traction on the cord or pressure from above. In a brief survey of recent American literature on the subject, in which 24 instances of this complication were reported by six observers, one is impressed by its frequent association with primiparity. Thus five of the women in the latter group were primiparae, while eleven had previously borne but one child. Williams8 quotes Beckmann and Vogel as citing a 50 per cent incidence of primiparous women in their series. The procedures generally mentioned for the treatment of inversion of the uterus may be briefly referred to as: