@article{oai:shiga-med.repo.nii.ac.jp:00003713,
 author = {桂, 大輔 and 森谷, 鈴子 and 辻, 俊一郎 and 鈴木, 幸之助 and 山田, 一貴 and 大橋, 瑞紀 and 木村, 文則 and 村上, 節 and KATSURA, Daisuke and Moritani, Suzuko and TSUJI, Shunichiro and SUZUKI, Kounosuke and YAMADA, Kazutaka and Ohashi, Mizuki and KIMURA, Fuminori and MURAKAMI, Takashi},
 issue = {1},
 journal = {Journal of Medical Case Reports},
 month = {Oct},
 note = {Background:
Uterine inversion may cause massive hemorrhage, resulting in maternal deterioration and death. Replacement of the inverted uterus must be performed as soon as possible. As time passes, the inverted uterus becomes atonic and necrotic, and a surgical approach may be required., Case presentation:
A 27-year-old Japanese woman was admitted to our hospital 4 hours postpartum with increased hemorrhage after the replacement of an inverted uterus. Recurrent inversion was diagnosed, and though the atonic uterus was replaced again by the Johnson maneuver, hemorrhage persisted. Balloon tamponade was not successful in stopping the hemorrhage, and uterine artery embolization was performed. Bleeding resumed the next day on removal of the balloon, and hysterectomy was performed. Massive hemorrhage, coagulopathy, and uterine necrosis caused uterine atony, and the reperfused blood flow on replacement of the ischemic uterus increased hemorrhage., Conclusions:
Cases of uterine inversion with coagulopathy lasting for more than 4 hours may require a surgical intervention, and uterine replacement may have to be delayed until the maternal hemodynamic condition is stabilized. Uterine replacement under laparotomy may be also be considered due to the risk of increased hemorrhage., Journal Article},
 title = {Uncontrollable uterine atony after replacement of uterine inversion managed by hysterectomy: a case report.},
 volume = {14},
 year = {2020}
}