Re: Inverted uterus
From: Anna Meenan, MD (annam@uic.edu)
Thu Jul 22 17:44:56 2004
I agree. A personal perspective: I suffered a partial uterine inversion
after the birth of my first. 3-hour second stage, 10-lb baby, fairly
large placenta followed promptly after baby. Video camera documentation
that the doc was NOT pulling on the cord as the placenta delivered (in
fact, if I recall correctly, she didn't even have a hand on it as it
started to emerge). The thing I remember most vividly is that I had a
severe INCREASE in pain immediately after delivery of placenta.
Definitely seemed different from the usual grunt and huge sigh of relief
that seemed to accompany the delivery of most of the placentas I had
delivered up to that point. I instantly knew we had trouble and for
some reason knew exactly what it was before the doc did. The consultant
ordered 100 mg meperidine IV and 100 IM, which resulted in the
incredible sensation that the rest of my body, except for the uterus, no
longer existed, and did absolutely nothing for the pain. Then an
anesthesiologist slapped a mask over my face and I woke up in recovery
with my uterus back in place. The nurse was on the phone and I heard
her say, "You're kidding-----ten pounds?" and I looked around the
recovery room to see who had given birth to a ten-pound baby, only to
find that I was the only patient in the room! What a day that was. The
kid is 20 now, and I'm beginning to think that a partial uterine
inversion was the easiest thing I've had to deal with in his lifetime.
--
Anna Meenan, MD
At Thu, 22 Jul 2004, Braun, R. Daniel wrote:
>
>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
>>>
>>> ---------------------------------------------------------------------
>>> -
>>> ---------------------------------------------------------------------
>>> ---------------------------------------------------------------------
>>> ---------------------------------------------------------------------
>>> --
>>> ---------------------------------------------------------------------
>>
>>> ---------------------------------------------------------------------
>-----------------------------------------
>>> ---------------------------------------------------------------------
>
