Uterine Inversion

Question 1

What is the most common cause of acute uterine Inversion?

Answer 1

Mismanagement of the 3rd stage of labour ( premature traction on umbilical cord and fundal pressure before separation of placenta

Question 2

What are the risk factors for uterine Inversion?

Answer 2

1- mismanagement of the 3rd stage
2- uterine atony
3- fundal implantation of adherent placenta
4- manual removal of the placenta
5- short umbilical cord
6- placenta praevia
7- connective tissue disorders
8- precipitate labour

Question 3

Is uterine Inversion predictable?

Answer 3

50 % unpredictable

Question 4

How is uterine Inversion classified?

Answer 4

*FIRST ( incomplete) : the inverted fundus extends to , but not beyond the cervical ring .
*SECOND ( incomplete) : the inverted fundus extends through the cervical ring,but remains within the vagina
* THIRD ( complete) : the inverted fundus extends down to the introitus
* FOURTH ( total) : the vagina is also inverted

Question 5

How is uterine Inversion presented?

Answer 5

94 % haemorrhage
With or without shock

Question 6

What kind of shocks the uterine Inversion causes?

Answer 6

Neurogenic with signs of bradycardia & hypotension

Question 7

What are the signs of uterine Inversion?

Answer 7

1- lump in the vagina
2- abdominal tenderness
3- absence of uterine fundus on abdominal palpitation
4- polypoidal red mass in the vagina with placenta attached

Question 8

What are the symptoms of uterine Inversion?

Answer 8

1- severe abdominal pain
2- sudden Cardiovascular collapse
3- postpartum hemorrhage

Question 9

What is the differential diagnosis of uterine Inversion?

Answer 9

1- uterovaginal prolapse
2- fibroid polyp
3- postpartum collapse
4- severe uterine atony
5- neurogenic collapse
6- coagulopathy
7- retained placenta without Inversion

Question 10

What is the management of uterine Inversion?

Answer 10

Resuscitation
Repositioning

Question 11

What is the maneuver in the manual replacement of the uterus in case of uterine Inversion?

Answer 11

JOHNSON
1- whole hand plus two thirds of the forearm in the vagina
2- holding the fundus in the palm & keeping the tips of the fingers at the uterocervical junction
3- the fundus is raised above the level of the umbilicus

Question 12

What is the hydrostatic correction of uterine Inversion?

Answer 12

HYDROSTATIC JV O ‘ SULLIVAN:
the bag of fluid should be elevated 100 - 150 cm above the level of the vagina to ensure sufficient pressure
( 2- 3 L of normal saline)
* difficulty in maintaining a tight seal at the introitus

Question 13

What is the role of tocolysis in the management of uterine Inversion?

Answer 13

1- MGSO4 ( 4-6 g ) IV over 20 min
( takes 10 minutes)
2- Nitroglycerin ( 100 mcg) IV slowly
( achieve uterine relaxation in 90 seconds when given sublingual
3- Terbutaline ( 0.25 mg) IV slowly
( takes 2 minutes)

Question 14

In a case of uterine Inversion ‘after successfully manual replacement , what is next?

Answer 14

1- remove placenta
2- massage
3- oxytocin
4- antibiotics

Question 15

If unsuccessful manual replacement during the management of uterine Inversion, and the woman is shocked , what is next?

Answer 15

General anesthesia

Question 16

What are the steps in managing uterine Inversion?

Answer 16

1- call for help
2- manual replacement : if unsuccessful:
* shocked ➡️ general anaesthesia
* not shocked ➡️
3- uterine relaxants: Terbutaline 0.25 mg IV or subcutaneous
Then
* manual or hydrostatic replacement
*if unsuccessful ➡️ general anaesthesia
* if unsuccessful ➡️ labarotomy

Question 17

What is the proportion of uterine Inversion that need laparotomy to manage?

Answer 17

< 3 %

Question 18

What are the surgical procedures for uterine Inversion?

Answer 18

1- HUNTINGDON operation
2- Haultain operation

Question 19

What is the Hantingdon’s operation?

Answer 19

To correct uterine Inversion
The abdomin is opened
A crater will be noted
2 allis forceps are introduced into the Crater & gentile upward traction

Question 20

What is the difference between Hantingdon’s & Haultain operation in the management of uterine Inversion?

Answer 20

In Haultain operation: the cervical ring is incised posteriorly with a longitudinal incision
The rest of the steps are similar