Pune: A 20-year-old woman resident of Bhosari, survived a life-threatening complication during her delivery. The woman was 38 weeks pregnant and went under the treatment at Pune based government-run Sassoon General Hospital (SGH). She was admitted for the Uterine inversion after her delivery when she tested positive for coronavirus.
On July 23, the woman was referred from Bhosari based hospital to Sassoon General hospital with a case of premature rupture of membranes. After admission in the hospital, the patient's vitals were observed to be good. She was 38 weeks pregnant with early labour. She had no other high risk medical or obstetric problems. Her COVID-19 antigen test was done on admission which was negative. She delivered a baby boy at 2 pm, with a good Apgar score. Delivery was conducted with keeping safety precautions like personal protective equipment (PPE) and safe distancing. But after delivery, the uterus reverted out of the introitus which is considered to be the third-degree uterine inversion.
The patient had sudden Tachycardia and Hypotension, based on which she immediately started resuscitation, and manual correction reposition of the uterus was done. The uterus was slightly atonic, so uterotonics were started. The uterus regained its tone and was in a normal position with fundus properly felt.
Dean, Dr Muralidhar Tambe, congratulated the OBGYN department for their accomplishments in dealing with the high-risk obstetric cases especially in COVID-19 positive mothers and told Sakal Times, "Due to vigilant monitoring, quick diagnosis, and immediate manual reposition of the uterus, major complications of uterine inversion like a neurogenic and hemorrhagic shock by which severe blood loss could be prevented. There was blood loss and she did not require any blood transfusion as she was monitored continuously in the labour room, which was stable. All her laboratory investigations were within normal limits."
He added, "Meanwhile patient's RT-PCR report was available, and she was found to be COVID-19 positive. So, the patient was shifted to COVID-19 ward for further management. Baby's swab was sent, and it came out to be negative. The mother was isolated from the baby and the baby was kept under pediatric supervision. In the COVID-19 ward, the patient was put on medications after a physician's consultation. Both Patient and newborn are now stable. Uterine inversion is a rare, life-threatening complication occurring in every 1 in 2,000 to 1 in 50,000 deliveries with a maternal mortality of around 15%. Most of the cases occur because of difficulties during conduction of delivery of the placenta. Excessive fundal massage, short umbilical cord, uterine anomalies, fundal placentation are among other high-risk factors in which uterine inversion can occur. Our case had a fundal attachment of placenta as per the ultrasound report, which could be the predisposing factor leading to uterine inversion."
He added, "Vigilant monitoring, careful removal of placenta after signs of separation seen, active management of the third stage of labour, and avoiding fundal pressure are the key measures for prevention of uterine inversion."
The patient was managed by the team of doctors in the labour room-Dr Anushka Mane, Dr Snehal Tinaikar, Dr Deepali Jadhav under the guidance of unit in-charge Dr Shilpa Naik, Associate Professor at BJGMC and SGH.
Dr Ramesh Bhosale Professor and Head of Department of Obstetrics and Gynecology said, "Apart from COVID-19 cases, the high-risk cases are also being managed at Sassoon Hospitals like hypertension in pregnancy and its complications like eclampsia, abruption. This is in addition to already existing caesarean and anaemia cases."