SALSO lecture - uterine inversion

1. UTERINE INVERSION

2. GOALS
1. To learn how to diagnose uterine
inversion
2. Steps to manage uterine inversion

3. 1
2
3

4. UTERINE INVERSION
Incidence : 1 in 2000 deliveries
Causes:
 Mismanagement of 3rd 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

5. CLASSIFICATION
1st Degree
- Inverted fundus
up to cervix
2nd Degree
- Body of uterus
protrudes through
cervix into vagina
3rd Degree
- Prolapse of
inverted uterus
outside vulva

6. 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)

7. 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

8. 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

9. 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

10. Silicon Vacuum cup

11. SURGICAL REPLACEMENT OF UTERUS
 Constricting ring stretched
 Posterior part of ring divided
 Fundus hooked up and resutured

12. PREVENTION
 Controlled Cord Traction – avoid excessive
traction
 Wait - Signs of placental separation
 NO Fundal Pressure