Uterine Inversion

Question 1

4 signs of placental separation

Answer 1

1. cord lengthening
2. gush of blood
3. globular uterine shape
4. Uterus lifting up to anterior abdominal wall
   * wait for these before putting traction on the cord

Question 2

2 risk factors for uterine inversion

Answer 2

1. fundally implanted placenta (esp in a grand-multip)

2. Placenta accreta

Question 3

What is treatment for uterine inversion– what 3 medicines can be used and what should be done to pt immediately

Answer 3

1. can use halothane, terbutaline or mag (relax uterus so can uninvert)
2. Put two large bore IV lines so can push fluids if massive hemorrhage occurs
   - once replaced, the tocolytics are stopped and pit is given to retighten uterus and stop bleeding
   - can also use fist to put uterus back

Question 4

what is the main cause of trouble with uterine inversion

Answer 4

Bleeding–> is nearly certain, even with optimal treatment. May need to go to OR to stop hemorrhage

Question 5

What is done for placentas that have not separated after 30 mins

Answer 5

Manual extraction.

-if mother is hemorrhaging, may have to perform emergency hysterectomy but manual extraction is done first