Acute Uterine Inversion Treatment PDF

### Uterine Inversion Uterine inversion presents with shock and haemorrhage. The main features of uterine inversion are shock out of proportion to blood loss and a bradycardia due to increased vagal tone. An urgent vaginal examination will reveal a mass in the vagina and the normally obvious post-p...

### Uterine Inversion Uterine inversion presents with shock and haemorrhage. The main features of uterine inversion are shock out of proportion to blood loss and a bradycardia due to increased vagal tone. An urgent vaginal examination will reveal a mass in the vagina and the normally obvious post-partum uterus cannot be felt above the symphysis. Incomplete versions present more subtly with continuing PPH despite a contracted uterus; the fundus of the uterus may feel dimpled. ### Pathway of care: Uterine Inversion - **Airway:** Maintain as level of consciousness requires - **Breathing:** Give 100% O₂ by face mask or bag and mask, if needed - **Circulation:** Shock. Usually severe - Insert wide bore i.v. cannulae x 2 (14G) - Send blood for FBC, 4 units x match, clotting - Give warmed crystalloid i.v. as rapidly as possible - Atropine 300-600 µg i.v. if heart rate <60/min - Establish monitoring of pulse, BP, urine output (via catheter) - Establish adequate analgesia and call for senior help if available - If Syntocinon is running stop it ### Attempt manual replacement as soon as possible: - Gently push the fundus back through the cervix - If the placenta is still attached leave it so #### If unsuccessful: - Hydrostatic replacement: - Get 2-5 L of warmed normal saline and attach the giving set onto a silastic ventouse cup. - Prime the system then place the ventouse in the vagina - Run in the fluid under gravity from a height of 2 m maintaining a seal manually at the introitus. - The reduction is usually achieved in approximately 10 mins. #### If fails (<3%): - Requires laparotomy. #### Once reduced: - Maintain hand in the uterine cavity until a firm contraction occurs, and i.v. oxytocin is being given. - Then remove the placenta and explore the cavity gently for trauma.