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Re: Inverted uterusFrom: Braun, R. Daniel (rbraun@iupui.edu)Wed Jul 21 11:05:29 2004
Why the figure of eight sutures? The one time that I did this, I didn't use them and it worked great with just the clamps on the rounds. Dan "Sound is like water. If you drill one hole in the wall the sound will leak right through." - JAY BRAUN, a band member by love, a soundproofer by necessity. -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of RModugno@aol.com Sent: Wednesday, July 21, 2004 7:42 AM To: Multiple recipients of list OB-GYN-L Subject: Inverted uterus Helped a colleague with an interesting case this last weekend - patient with an inverted uterus. Primigravida, delivered by CNM - presented with post-partum hemorrhage - inverted uterus found. Despite general anesthesia and attempts at cervical relaxation with IV nitroglycerin - manual reposition failed. At laparotomy she had a classic uterine invesion. A modified Huntington's technique was used to correct the inversion: figure of 8 sutures were placed in the anterior and posterior uterine walls at the edge of the "crater", and kelly clamps were applied to the round ligaments. Upward and outward traction was applied to the kelly clamps and to hemostats attached to the figure of 8 sutures. As the uterus began to "right" itself, further figure of 8's were placed on the anterior and posterior eges of the crater until the uterus was completely back in position. It's amazing how much less stressful it is when it's not your patient! Even more amazing:Many of the OB's when told about this case said:"You mean you didn't have to do a hyst?" Seems like we need to do some CME on the management of this frightening,unusual, potentially fatal condition! Robert Modugno MD MBA FACOG Marietta, GA http://www.novaobgyn.yourmd.com
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