ECTROPION OF THE UTERUS (inversio uteri) — pathological process, at Krom a uterus is partially or completely turned out by a mucous membrane of a knaruzha, passing through an expanded pharynx in a vagina, and can drop out outside (fig.). Century of m — a rare complication of the afterbirth and puerperal periods. According to Tsangemeyster (W. Zangemeister, 1925), observes one case on 400 000 childbirth. Century of m can be combined with a full prolapse of the uterus.
The ectropion can arise at an atonichny uterus as a result of a rough pandiculation for an umbilical cord or at use of a method of Krede at even badly reduced uterus (see. Afterbirth period ). The uterine fundus falls and entrains uterine tubes and ovaries, but thanks to counteraction of sheaves they do not plunge into the formed funnel.
Nek-ry authors believe that in puerperal V.'s etiology of m the large role is played by jump of pressure in a cavity of the uterus owing to its bystry emptying.
Even less often the so-called onkogenetichesky ectropion meets. It can occur at the birth of the submucosal fibromyoma located in an uterine fundus.
A clinical picture
puerperal V.'s Signs of m are extremely various. At acute V. the m observe the phenomena of shock and bleeding from the placental platform, small frequent pulse, vomiting, dizziness, a syncope, pallor. When the acute phenomena pass, the patient complains of frequent desires to an urination, feeling of a raspiraniye to a vagina and pressure upon a rectum. If the ectropion is not distinguish at once, the dropped-out uterus can be restrained, hypostasis and even its necrosis develops. Sometimes there is a spontaneous reposition of a uterus. In nek-ry cases the lethal outcome, hl was observed. obr. from shock. The air embolism can be a possible cause of death.
Recognition of a full ectropion is simple. At partial V. m a bimanual research funneled deepening allows to find on site bodies of the womb, in a vagina the tumor is probed, over a cut the ring-shaped education (a uterine pharynx) which is densely covering a tumor is had. Cases of total absence of signs when the ectropion was established only in several days after the delivery were observed. Signs hron. Century of m are pains in a sacrum, in a stomach, feeling of a raspiraniye in a vagina, bloody allocations. V. F. Snegirev points to extraordinary pallor of the patient. The similar picture is observed and at onkogenetichesky V. of m
Treatment pursues two aims: to return a uterus to its normal situation and to hold it in this situation. At acute puerperal V.'s treatment m it is necessary to try to set a uterus. Reposition needs to be made on a gynecologic chair under etherization. Tsangemeyster considers the best time for reposition the first 2 — 6 hours after the occurred ectropion.
Technology of reposition of acute puerperal V. of m is very various. One authors recommend to enter a hand into a vagina, to take entirely a body of the womb and to squeeze it within several minutes to squeeze out blood and a lymph of walls of a uterus and to these to reduce the volume of a vyvorochenny uterus, and after that very carefully to advance it through a narrow part of a funnel (neck of uterus). At this time support by other hand through an abdominal wall edge of a funnel. Other authors do not recommend to make squeezing, and advise to enter two fingers into a vagina and it is possible to push aside them further a sidewall of a vagina aside; thanks to it the vyvorochenny uterus will be less clamped and it is easier to set it. In the presence of an afterbirth on a vyvorochenny uterus it should be removed before reposition.
After reposition enter into a vagina a kolpeyrinter (see. Colpeurysis ), appoint the drugs causing reduction of a uterus (Pituitrinum, mammophysin, oxytocin).
Treatment of an onkogenetichesky ectropion — only surgical. From the numerous methods of operation applied at V. by m, the best results are yielded by Kyustner's method — Piccoli (see. Kyustnera-Piccoli operation ).
At acute puerperal V. of m, in case of timely reposition of a uterus, the forecast is favorable. At an onkogenetichesky ectropion the forecast can be favorable for life only at surgical treatment.
It is necessary to follow all rules of modern obstetrics during the maintaining afterbirth and early puerperal the periods and especially carefully and to carefully apply Krede's method.
Bibliography: Braude I. L., Malinovsky M. S. and G e r e the blvd. about in A. I. Not operational gynecology, M., 1957; Pankova] E. V. An acute ectropion of a uterus in a puerperal period, Akush, and ginek., No. 4, page 128, 1963; Persianinov L. S. Operational gynecology, M., 1971; G of e e η h i 11 J. P. a. Friedman E. A. Biological principles and modern practice of obstetrics, Philadelphia, 1974; Gupta U. Agarwal S. Inversion of the uterus, J. Obstet. Gynaec. India, v. 21, p. 533, 19 71.
I. L. Braude.