Acute Uterine Inversion Complicating Mid-Trimester Unsafe Abortion in a Teenage Nigerian Girl

  • S Nyeche
  • AE Ubom
Keywords: Acute Uterine Inversion, Gangrene, Pregnancy termination, Unsafe abortion, Vaginal hysterectomy, Teenager


Uterine inversion is a rare but life-threatening obstetric emergency, complicating 1 in 2,000 to 1 in 50,000 deliveries. Very rarely, this condition also complicates unsafe abortion. A case of acute complete (fourth-degree) uterine inversion, with gangrene of the uterus in an 18-year-old nulliparous girl who presented to the Gynaecologic Emergency Unit of the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria, in hypovolemic shock from massive haemorrhage following unsafe mid-trimester termination of unwanted pregnancy is reported. She was adequately resuscitated, and a vaginal hysterectomy was performed. The patient was discharged following an uneventful postoperative period. This case highlights the consequences of the high unmet need for family planning and the restrictive abortion laws in Nigeria, limiting access to effective contraception and safe abortion services, thereby increasing the risk of maternal mortality and morbidity from complications of unsafe abortion


Sharma R, Malhotra S, Dogra P, Kumar A, Kaushal S, Priya T. Puerperal sub-acute uterine inversion: a rare case report. Int J Reprod Contracept Obstet Gynecol 2017; 6: 3709-3711.

Leal RF, Luz RM, de Almeida JP, Duarte V, Matos I. Total and acute uterine inversion after delivery: a case report. J Med Case Rep 2014; 8: 1-4.

Pauleta JR, Rodrigues R, Melo MA, Graça LM. Ultrasonographic diagnosis of incomplete uterine inversion. Ultrasound Obstet Gynecol 2010; 36: 260-261.

Mishra S. Chronic uterine inversion following mid-trimester abortion. J Obstet Gynaecol India 2018; 68: 320-322.

Herath RP, Patabendige M, Rashid M, Wijesinghe PS. Non-puerperal uterine inversion: what the gynaecologists need to know? Obstet Gynecol Int 2020; 2020.

Bankole A, Adewole IF, Hussain R, Awolude O, Singh S, Akinyemi JO. The incidence of abortion in Nigeria. Int Perspect Sex Reprod Health 2015; 41: 170-181.

Oye-Adeniran BA, Umoh AV, Nnatu SNN. Complications of unsafe abortion: a case study and the need for abortion law reform in Nigeria. Reprod Health Matters 2002; 10: 19.

National Population Commission [Nigeria] and ICF International. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International.

Dwivedi S, Gupta N, Mishra A, Pande S, Lal P. Uterine inversion: a shocking aftermath of mismanaged third stage of labour. Int J Reprod Contracept Obstet Gynecol 2013;2(3):292-296.

Modares M, Sarrazin J. Non-puerperal vaginal hemorrhage secondary to complete uterine inversion: A case report. Radiol Case Rep 2021; 16: 543-546.

Garg P, Bansal R. Unusual and delayed presentation of chronic uterine inversion in a young woman as a result of negligence by an untrained birth attendant: a case report. J Med Case Rep; 2020; 14: 1-5.

Sunitha RV. An unusual case of uterine inversion. J Clin Diagn Res. 2011; 5: 650–651.

Begum N, Ganguly S, Anwer BR, Islam F. Inversion of uterus-presenting as a complication of abortion. Bangladesh J Obstet Gynaecol 2014; 29: 54-55.

Smulian JC, DeFulvio JD, Diven L, Terraza JL. Sonographic findings in acute uterine inversion. J Clin Ultrasound 2013; 41: 453-456.

Adesiyun AG. Septic postpartum uterine inversion. Singapore Med J 2007; 48: 943-945.

Johnson AB. A new concept in the replacement of the inverted uterus and a report of nine cases. Am J Obstet Gynecol 1949; 57: 557-562.

Owaraganise A, Tibaijuka L, Ngonzi J. Subacute uterine inversion following an induced abortion in a teenage girl: a case report. BMC Women’s Health 2020; 20: 220.

O’Sullivan JV. Acute inversion of the uterus. BMJ 1945; 2: 282-284.

Ogueh O, Ayida G. Acute uterine inversion: a new technique of hydrostatic replacement. Br J Obstet Gynaecol 1997; 104: 951-952.

Huntington JL. Acute inversion of the uterus. Boston Med J 1921; 184: 376-380.

Antonelli E, Irion O, Tolck P, Morales M. Subacute uterine inversion: description of a novel replacement technique using the obstetric ventouse. Br J Obstet Gynaecol 2006; 113: 846-847.

Shepherd LJ, Shenassa H, Singh SS. Laparoscopic management of uterine inversion. J Minim Invasive Gynecol 2010; 17: 255-257.

Case Report