Re: Inverted uterus
From: Efrain Ramirez (eramirezt@coqui.net)
Thu Jul 22 19:16:22 2004
Exacto pero -- I've seen a lot of fundal implantations - no inversions
-- it's go to have some predsisposition - whatever that means....
>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
>>>
>>> ---------------------------------------------------------------------
>>> -
>>> ---------------------------------------------------------------------
>>> ---------------------------------------------------------------------
>>> ---------------------------------------------------------------------
>>> --
>>> ---------------------------------------------------------------------
>>
>>> ---------------------------------------------------------------------
>-----------------------------------------
>>> ---------------------------------------------------------------------
>
--
"The opposite of a correct statement is a false statement.
But the opposite of a profound truth may well be another profound truth."
Niels Bohr (1885 - 1962)
