Uterine Inversion

Uterine inversion SALSO Course Sarawak General Hospital Uterine inversion

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

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

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)

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

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

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

Surgical replacement of uterus
Constricting ring stretched
Posterior part of ring divided
Fundus hooked up and resutured

Prevention
Controlled Cord Traction – avoid excesive traction
Wait - Signs of placental separation
NO Fundal Pressure

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Uterine Inversion

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