Re: Inverted uterus
From: Braun, R. Daniel (rbraun@iupui.edu)
Thu Jul 22 12:16:56 2004
Inverted uterus results fro a direct central fundal placental implantation. NOT from cord traction.
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 Seele, Mona
Sent: Thursday, July 22, 2004 10:25 AM
To: Multiple recipients of list OB-GYN-L
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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