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Uterine Inversion
Uterine Inversion
Uterine Inversion
Uterine Inversion
Uterine Inversion
Uterine Inversion
Uterine Inversion
Uterine Inversion
Uterine Inversion
Uterine Inversion
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Uterine Inversion

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SALSO Series - Uterine Inversion

SALSO Series - Uterine Inversion

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  • 1. Uterine inversion SALSO Course Sarawak General Hospital Uterine inversion
  • 2. 1 2 3
  • 3. Uterine inversion
    • Incidence : 1 in 2000 deliveries
    • Causes :
    • Mismanagement of 3 rd stage
    • Excessive cord traction (esp. with an unseparated placenta)
    • Excessive fundal pressure (esp. when uterus is poorly contracted @ atonic)
    • Placenta accreta
    • Congenital predisposition
    • Fundal implantation of placenta
  • 4. Classification 1 st Degree - Inverted fundus up to cervix 2 nd Degree - Body of uterus protrudes through cervix into vagina 3 rd Degree - Prolapse of inverted uterus outside vulva
  • 5. Clinical presentation
    • Abdominal pain
    • Post-partum haemorrhage
    • Sudden collapse – degree of shock may be inconsistent with the amount of blood loss
    • Absence of uterine fundus @ depression over fundus
    • Fleshy mass at or outside the introitus (dark red-blue bleeding mass)
  • 6. Management
    • Prompt recognition and treatment
    • Should be suspected if profound shock without obvious explanation
    • Treat vasovagal shock (i.e. ABC, IV access, GXM)
    • Placental should not be detached until the uterus is replaced and contracted
    • Replace uterus immediately- several techniques Manual or hydrostatic replacement
    • Surgical replacement
    • May require tocolytics, anaesthesia, or both
  • 7. Manual replacement of uterus
    • Replace by pressing first on that part of the uterus which inverted last
    • Once replaced, keep hand inside uterus until ergotmetrine or oxytocin has produced a firm contraction
  • 8. O’Sullivan’s hydrostatic method
    • Tube passed into the posterior fornix
    • Assistant close vulva around operator’s wrist
    • Warm saline run in until pressure gradually restores position of uterus
  • 9. Surgical replacement of uterus
    • Constricting ring stretched
    • Posterior part of ring divided
    • Fundus hooked up and resutured
  • 10. Prevention
    • Controlled Cord Traction – avoid excesive traction
    • Wait - Signs of placental separation
    • NO Fundal Pressure

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