Uterine Inversion

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SALSO Series - Uterine Inversion

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Uterine Inversion

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

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