INVERSION OF THE UTERUS DEFINITION It is a

INVERSION OF THE UTERUS

DEFINITION • It is a condition in which uterus is turned inside out partially or completely • Life threatening complications in the third stage of labour

TYPES q FIRST DEGREE ü Dimpling of the fundus ü Uterus remains above the level of internal os q SECOND DEGREE ü Fundus passes through the cervix ü But lies inside the vagina q THIRD DEGREE ü Endometrium with or without the attached placenta is visible outside the vulva ü The cervix and part of the vagina may also be involved in the process

ETIOLOGY q SPONTANEOUS ü Localised atony of the placental site ü Sharp rise of intra abdominal pressure ü Short cord ü Placenta accreta q INDUSED Mismanagement of third stage ü Pulling the cord ü Crede’s expression ü Faulty technique in manual removal

DANGERS q SHOCK ü Tension on the nerve ü Pressure on the ovaries ü Peritoneal irritation q HAEMORRHAGE q PULMONARY EMBOLISM q INFECTION q UTERINE SLOUGHING q CHRONIC

DIAGNOSIS q SYMPTOMS ü Lower abdominal pain with bearing down sensation q SIGNS ü Shock ü Cuppling or dimpling at the fundus ü Fundus cannot be made out ü A reddish purple pear shaped mass protrudes outside the vulva

PREVENTION q Do not expel placenta when uterus is relaxed q Pulling the cord simultaneously with fundal pressure should be avoided q Manual removal should be done with caution

MANAGEMENT q Before shock Urgent manual removal even without anaesthesia Ø To replace that part first which inverted last Ø To apply counter support with other hand placed on the abdomen Ø Hand should remain inside until the uterus becomes contracted Ø Placenta is to be removed manually only after the uterus becomes contracted Ø Treatment for shock

Contd… q After the shock Ø Treatment of shock Ø Push the uterus inside ØPack the vagina with antiseptic roller gauze Ø Raise the foot end of the bed Ø Replacement of the uterus