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Uterine inversion 2016
Uterine inversion occurs when the uterus turns inside out, most commonly during delivery from excessive cord traction or fundal pressure. It has an incidence of 1 in 2000 deliveries. Uterine inversion can be first, second, or third degree depending on how far the uterus prolapses. Symptoms include abdominal pain, postpartum hemorrhage, and shock. Treatment requires prompt recognition and replacement of the inverted uterus manually or with hydrostatic pressure before detaching the placenta, as well as treatment for shock. Prevention focuses on controlled cord traction and avoiding fundal pressure until after placental separation.
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Introduction to uterine inversion as a medical condition.
Goals include diagnosing uterine inversion and managing it effectively.
Incidence is 1 in 2000 deliveries; Causes include mismanagement of 3rd stage, excessive cord traction, and congenital predisposition.
Three degrees of inversion: 1st degree (fundus to cervix), 2nd (body through cervix), and 3rd (prolapse outside).
Symptoms include abdominal pain, post-partum hemorrhage, shock, absence of uterine fundus, and dark red-blue mass.
Emphasizes prompt recognition; treatment includes vasovagal shock management, and immediate uterine replacement.
Technique involves pressing on the last part inverted and maintaining uterine contraction with medications.
O’Sullivan’s method involves using warm saline through the vagina to restore uterine position.
Involves stretching the constricting ring, division of the posterior part, and resuturing the fundus.
Preventive measures include controlled cord traction, waiting for placental signs, and no fundal pressure.
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Uterine inversion 2016
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- 2. GOALS 1. To learnhow to diagnose uterine inversion 2. Steps to manage uterine inversion
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- 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 - Invertedfundus up to cervix 2nd Degree - Body of uterus protrudes through cervix into vagina 3rd Degree - Prolapse of inverted uterus outside vulva
- 6. CLINICAL PRESENTATION Abdominalpain 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 recognitionand 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 OFUTERUS 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
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- 11. SURGICAL REPLACEMENT OFUTERUS Constricting ring stretched Posterior part of ring divided Fundus hooked up and resutured
- 12. PREVENTION Controlled CordTraction – avoid excessive traction Wait - Signs of placental separation NO Fundal Pressure