Uterine Inversion

Question 0

Four signs of placental separation?

Answer 0

1. Gushing blood
2. Lengthening of the cord
3. Globular and firm shape of the uterus
4. Uterus rises up to anterior abdominal wall

Question 1

Most common cause uterine inversion?

Answer 1

Undue traction of the cord before placental separation

Question 2

Abnormally retained placenta?

Answer 2

Third stage of labor that has exceeded 30 minutes

Question 3

Uterine inversion?

Answer 3

Fundus of the uterus moves through the cervix into the vagina

Question 4

Patient at particular risk of uterine inversion?

Answer 4

Grand-multiparous patient with placenta attached to fundus

Question 5

Patient with inverted uterus – treatment?

Answer 5

1. Two large bore IV lines
2. Uterine relaxation – halothane
3. If placenta has separated, manual replacement of uterus
4. Terbutaline or magnesium sulfate to relax uterus (if necessary)
5. Once in normal location, uterotonic agents (oxytocin)

Question 6

Patient with an abnormally retained placenta – next step?

Answer 6

Manual extraction attempt

Question 7

Point of giving oxytocin?

Answer 7

Allows uterus to contract down on itself, stopping bleeding

Question 8

Inaccessible inverted uterus, next step?

Answer 8

Uterine relaxing agent (halothane) >terbutaline/magnesium sulfate

Question 9

Why does inverted uterus cause hemorrhage?

Answer 9

Unable to contract, therefore unable to temper bleeding

Question 10

Most common cause of hemorrhage in inverted uterus?

Answer 10

Uterine atony