Inverted Uterus

Question 1

Define the 3 types of inverted uterus

Answer 1

First degree - fundus inverted but does pass through cervix
Second degree - fundus protrudes through the cervix and lies in the vagina
Third degree - uterus completely inverted, appears outside the vulva

Question 2

What is the incidence?

Answer 2

1 : 28,000

Question 3

Name some causes of an inverted uterus

Answer 3

• Adherent placenta
• Short umbilical cord
• Spontaneous
• Excessive fundal pressure
• Rapid emptying of the uterus

Question 4

Name some signs and symptoms of an inverted uterus

Answer 4

• Varying degrees of shock
• Haemorrhage
• Pain
• Urinary retention

Question 5

What is the immediate management of an iverted uterus

Answer 5

• Help : 2222 : obstetric emergency
• Explain concerns to woman and partner
• Confirm diagnosis
• Access A, B, C
• Facial oxygen (15l/min)
• IV access and cross match
• Analgesia
• IVI fluids
• Catheter
• Attempt immediate manual replacement

Question 6

How is the uterus repositioned?

Answer 6

JOHNSONS MANOEUVRE

• Insert the hand
• Cup the fundus
• Exert pressure upwards and backwards towards the posterior fornix
• Feed the uterus back through the cervix

O’SULLIVANS METHOD

• Under GA
• Several litres of warmed normal saline into the vagina via a giving set
• Obstetrician seals off the introitus to stop the water escaping

Question 7

What is the postnatal care following an inverted uterus?

Answer 7

• High dependency on labour ward
• Normal post op care
• Broad spectrum antibiotics
• Debriefing with woman, family and MDT
• Datex
• Record keeping