Acute postpartum uterine inversion with haemorrhagic shock: laparoscopic reduction: a new method of management?

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Sir,

I thank Moran for his interest and contribution to my commentary on the case report by Vijayaraghavan and Sujatha on laparoscopic reduction of acute postpartum uterine inversion with haemorrhagic shock.1–3 I agree that with him that the majority of cases of acute uterine inversion presenting with shock because of either haemorrhagic or neurogenic cause or both.4 Out of these two causes, haemorrhagic shock is more common than neurogenic shock.5 A recently published case series of 36 acute uterine inversions occurring over a period of 8 years with 57 036 deliveries reported that although hypovolaemic shock was present in 69% of cases, the cause of shock was also deemed to be neurogenic in 13% of cases.6 The intention of my commentary was merely to highlight that the shock in such patients can sometimes be because of the neurogenic component, in which case, the extent of it can be out of proportion to the amount of blood loss during the delivery.

Ancillary