Re: Inverted uterus
From: Gerald P. Rodríguez (geraldpr@cybermesa.com)
Thu Jul 22 11:21:15 2004
I have seen/managed 6 or so inverted uteri. Saw one managed with ethyl
ether (!) during my internship at LA County ('66). Halothane when the
patient required anesthesia is/was a wonderful myometrial relaxing agent.
The last one I managed was a home-birth who rolled in white as a sheet with
bradycardia and in shock. She was so obtunded that I did the left hand in
vagina, right hand on abdomen maneuver and gradually over three minutes got
the fundus back in place without anesthesia. Soon as I did this her blood
pressure and pulse rapidly improved. I believe there is a strong vagal
component to this phenomenon resulting sometimes in profound hypotension
that is way out of proportion to the blood loss.
Gerald P. Rodríguez, M.D., FACOG
Santa Fe
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"There is nothing so pitilessly and unconsciously cruel as
sincerity formulated into dogma." In defense of Abe Lincoln.
--James Russell Lowell 1863
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>----- Original Message -----
From: "Seele, Mona" <Mseele@tmh.tmc.edu>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
Sent: Thursday, July 22, 2004 9:24 AM
Subject: Re: Inverted uterus
> I have seen it when I did a precip delivery without an md. I never pull
on
> the cord when I deliver a baby because I would like to give the doctor
time
> to get there to deliver the placenta if possible so maybe it was related
to
> the rapid descent and expulsion in a grand multip's uterus. I had seen it
> before and the physician at that one showed me how to push it back with my
> hand and it worked beautifully. A few months after that I was doing a
> delivery with a relatively inexperienced md and he had one; I told him how
> to do it and he had no problems either.
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Bernard
> Cristalli
> Sent: Thursday, July 22, 2004 10:12 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Inverted uterus
>
> Inversion is quite exceptional around here, perhaps because pulling on the
> cord is "strengt verboten".
> I've seen one in 20 years.
>
> --
> Bernard Cristalli MD AMACOG
> AIHP - ACCA
> Paris France
> http://www.CliniquedelEssonne.fr
> http://www.obgyn.net/corresp/cristalli.htm
> http://www.gyneweb.fr
> '64 Mk2 3.8
>
> > De : "Braun, R. Daniel" <rbraun@iupui.edu>
>
> >
> > What about water embolism? In my experience, the 9 or ten that I have
> > seen and have been diagnosed in the first 5 minutes, have responded to
> > pushing the fundus up using the knuckles of the intravaginal hand. The
> > one that was transferred in from an outlying hospital, after having been
> > inverted for several hours is the only one that needed any surgical
> > intervention.
> > IOW, like everything else, rapid diagnosis and management is what works
> > best. Delay in diagnosis and management leads to increased morbidity and
> > mortality.
> >
> > 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 Steve
> > & Eryl Raymond
> > Sent
> list OB-GYN-L
> > Subject: Re: Inverted uterus
> >
> > 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 post
> y 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
> >>
> >> ----------------------------------------------------------------------
> >> --
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> >
>
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