Examination of a pregnant woman reveals that her endometrium (with the attached placenta) is visible outside the vulva, and inverted fundus extends outside of the vagina. Which of the following is the probable diagnosis?
Explanation
Answer: D - Third degree uterine inversion
Inversion of the uterus is a rare complication in the third stage of labor, and can be life - threatening. After the baby is born, the placenta fails to detach from the uterine wall. Instead, it exits the vagina; the result is that the uterus is partially or completely turned “inside out”. There are three degrees of uterine inversion as follows: 1) First degree (in which the inverted fundus extends to-but not through- the cervix); 2) Second degree (in which the inverted fundus extends through the cervix, but remains within the vagina); and 3) Third degree (in which the inverted fundus extends outside of the vagina). Additionally, uterine inversion is usually categorized as either incomplete or complete. In incomplete inversion, the top of the uterus (fundus) has collapsed, but the uterus hasn’t come through the cervix. In complete inversion, the uterus is “inside - out” and coming out through the cervix. Prolapsed inversion is a description applied when the fundus of the uterus is coming out of the vagina.
