This method is used to reduce uterine inversion if manual method is unsuccessful.
- Need to exclude uterus perforation by clinical inspection.
- The operator need to hold the inverted uterus within the vagina
- The introitus need to be sealed by the 2 hands of an assistant
- Infuse 2 litre of warm saline (e.g.: use 1000ml bags of saline through a silastic ventous cup, urological Y giving set, or with a funnel and anesthetic machine scavenging tubing)
Related:
Reference:
- Brian Magowan. Churchill’s Pocketbooks Obstetrics and Gynaecology. 3rd edition. Elsevier Churchill Livingstone.
Uterine inversion is one of the obstetric emergencies. It means that the fundus of the uterus has prolapsed through the cervix. In other words, the uterus is turned inside out. Uterus inversion occurs after delivery and worsened by excess traction on the cord before placental separation. Luckily, the incidence of uterine inversion has decreased (particularly in Malaysia) with the good management of 3rd stage of labour.
Degree of uterine inversion:
- 1st degree – fundus of uterus does not herniate through level of internal os
- 2nd degree – fundus of uterus passes through the cervix & lies within vagina (the commonest type)
- 3rd degree – entire uterus hangs outside vulva
Predisposing factors of uterine inversion:
- Many cases of uterine inversion result from mismanagement of the third stage of labor: excessive traction on the umbilical cord; excessive fundal pressure; excessive and vigorous manual removal of the placenta.
- relaxed uterus, lower uterine segment and cervix
- placenta accrete (placenta embedded in the uterine wall), particularly involving the uterine fundus
- short umbilical cord
- congenital weakness or anomalies of the uterus
- antepartum use of Magnesium Sulphate or Oxytocin
When to suspect uterine inversion?
- A dark red–blue bleeding mass visible at the cervix, in the vagina, or outside the vagina.
- Depression or absent of the fundus of uterus on abdominal examination (unable to palpate the uterus)
- Patient presented with signs and symptom of hypovolemic shock ( low blood pressure, tachycardia / heat rate > 100/min without any obvious cause)
- Sudden collapse
Management of uterine inversion:
- Treat hypovolemic shock vigorously with fluid (preferably colloid) and blood replacement.
- Raise foot of the bed to keep the inverted uterus in vagina
- If the placenta is not delivered yet, DO NOT detach the placenta until the uterus is replaced and contracted.
- Exclude uterine perforation by clinical inspection
- Reduce the uterine inversion. Once corrected (by manual or O’ Sullivan’s technique, 1ml of intramuscular syntometrine should be given stat.
- Method of uterine replacement:
- Manual correction – if the prolapsed is easily reducible
- O’Sullivan hydrostatic pressure technique
- Surgical correction – laparatomy need to be considered if all other measures fail. It may be possible to partially divide the constriction ring ( the ring formed at the point where the uterus has inverted)
- Hysterectomy may be necessary.
Related:
Reference:
- Brian Magowan. Churchill’s Pocketbooks Obstetrics and Gynaecology. 3rd edition. Elsevier Churchill Livingstone.
