Uterine Inversion

Question 1

Call for help

Answer 1

• 2222
• obstetric emergency
• SOAPS
• replace uterus simultaneously to the A-E assessment

Question 2

Airway

Answer 2

• head tilt, chin lift
• consider airway adjunct
• Trendelenburg

Question 3

Breathing

Answer 3

• high flow O2 10-15L via a non re-breath mask
• check for fogging
• signs of respiratory distress

Question 4

Circulation

Answer 4

• IV access 2x14g cannula
• bloods- FBC, G+S, cross match
• fluids- up to 1L to support BP- consider more/blood if haemorrhaging
• urinary catheter- 0.5mls/kg/hr
• obs every 3-5 mins
• fluid balance chart

Question 5

Disability

Answer 5

• AVPU
• pupil size
• drugs
• blood glucose

Question 6

Exposure

Answer 6

• observe top to toe- replace uterus
• temperature

Question 7

Immediate Care

Answer 7

• treat the cause
• replace uterus to reverse neurogenic shock
• leave placenta for manual removal
• adequate analgesia

Question 8

Johnson’s Manoeuvre

Answer 8

• lie bed flat and raise foot of bed
• cup inverted fundus in hand
• replace uterus into body
• feed uterus back through cervix aiming for umbilicus

Question 9

Oxytocics

Answer 9

• maintain contraction and allow cervix to reform
• 500mcg ergometrine
• 40 IU

Question 10

Tocolytics

Answer 10

• if difficult to replace
• terbutaline 0.25mg sub-cut

Question 11

Other Medical Interventions

Answer 11

• O’sullivan’s- replacement of uterus with hydrostatic pressure
• general anaesthetist- relax contraction ring and allow manual removal
• surgical incision- cut cervical contraction ring
• hysterectomy

Question 12

Ongoing Care

Answer 12

• monitor for signs of PPH
• increased level of observation
• emotional support- debrief
• feeding support
• antibiotic prophylaxis to prevent infection
• document all actions