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Re: Inverted uterusFrom: Dr Riaan vd Colf (rvdcolf@mweb.com.na)Thu Jul 22 02:51:14 2004
Originally called the O'Sullivan method - works very well. Have done a few - never had to do a laparotomy to correct one. Dr Riaan vd Colf Windhoek Namibia
> ----- Original Message ----- Steve What an interesting technique? Do you have a case report or reference for your hydrostatic method? I've had great luck with the nitroglycerine pushed IV very slowly. Relaxed a uterus that another physician had caused to have a rather firm contraction ring. ************************************************************************* Charlie Chambers Hood River, OR cchamber@alumni.rice.edu "No matter where you go... there you are." Dr. Buckaroo Banzai ************************************************************************ On Jul 21, 2004, at 9:34 PM, Steve & Eryl Raymond wrote:
I echo the congratulations in this case, because of the good outcome, but I would also say that I have experienced two of these and managed successfully to reduce them without surgery using the hydrostatic method. What is required is a large funnel (in fact the old fashioned douche can that I found on the first occasion was best of all) and some tubing of the type usually available as suction tubing. The hand holding one end of the tube is placed in the vagina with the other end attached to the funnel, and sterile water, or saline, is poured into the funnel held at a height of a meter or more above the patient. Making sure that the labia are held round the vaginal hand so as to prevent water coming out of the vagina, and with patience, the water pressure slowly reduces the inversion. You need to use a couple of liters. It helps to relax the uterus with whatever - halothane, nitroglycerine, amyl nitrite - and hey presto no scar! Steve Exuma Pierre Tony wrote: CONGRATULATIONS ROBERT!!!!!! DR EXUMA,MD,OBGYN RModugno@aol.com wrote: 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. I! t'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 Vote for the stars of Yahoo!'s next ad campaign! <http://advision.webevents.yahoo.com/yahoo/votelifeengine/>
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