Inversion of the Uterus Approches to managemet.ppt

Help to understand the inversion

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

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

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

8. DANGERS
 SHOCK
 Tension on the nerve
 Pressure on the ovaries
 Peritoneal irritation
 HAEMORRHAGE
 PULMONARY EMBOLISM
 INFECTION
 UTERINE SLOUGHING
 CHRONIC

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

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

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

13. Contd…
 After the shock
 Treatment of shock
 Push the uterus inside
Pack the vagina with antiseptic roller gauze
 Raise the foot end of the bed
 Replacement of the uterus