Uterine Inversion

Question 1

Uterine Inversion

Answer 1

Rare complication of birth, where the fundus of the uterus drops down through the uterine cavity and cervix, turning the uterus inside out

Life-threatening obstetric emergency

Question 2

Incomplete uterine inversion

Answer 2

Is where the fundus descends inside the uterus or vagina, but not as far as the introitus (opening of the vagina).

Question 3

Cause of uterine inversion

Answer 3

May be result of pulling the umbilical cord too hard during active management of the third stage of labour

Question 4

Presentation of uterine inversion

Answer 4

Large postpartum haemorrhage
Maternal shock or collapse

Incomplete uterine inversion may be felt with manual vaginal examination.

Complete uterine inversion, the uterus may be seen at the introitus of the vagina

Question 5

Management of uterine inversion

Answer 5

Johnson manoeuvre
Hydrostatic methods
Surgery

Question 6

Johnson manoeuvre

Answer 6

Involves using a hand to push the fundus back up into the abdomen and the correct position.

The whole hand and most of the forearm will be inserted into the vagina to return the fundus to the correct position.

It is held in place for several minutes, and medications are used to create a uterine contraction (i.e. oxytocin).

The ligaments and uterus need to generate enough tension to remain in place

Question 7

Hydrostatic methods

Answer 7

Filling the vagina with fluid to “inflate” the uterus back to the normal position.

It requires a tight seal at the entrance of the vagina, which can be challenging to achieve

Question 8

Surgery for uterine inversion

Answer 8

Laparotomy