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Re: Inverted uterusFrom: Betsy Hyde (elishyde@mindspring.com)Thu Jul 22 21:46:20 2004
On Thursday, July 22, 2004, at 06:45 PM, Anna Meenan, MD wrote:
> Video camera documentation I had a uterine inversion recently.. My only one in approx 2000 births. I did nothing differently. Primip. Normal labor and 2nd stage. Brandt-Andrews negative. I was just sitting there, chatting. Gentle controlled cord traction resulted in very severe pain as the placenta delivered. You know how people say "well, I've never seen this before...how will I know?" I knew instantly that the uterus had inverted. I simultaneously called for anesthesia, my attending, the chief resident, nursing support. The patient was fine. I attempted to palm it,, walk my fingers up and replace it, but couldn't. Tried to put my fist in the center, and replace it...but no luck there either. Now...here is the question..... It was clearly a fundal implantation, and the whole uterus was out. The patient was hemodynamically stable...probably because the placenta was through the cervix and there was no vagal stimulation, and no bleeding. The chief resident peeled the placenta from the uterus, and then tried to repositon it. He couldn't. By then my attending was there, we went to the OR, she got some nitroglycerine, and the uterus was respositioned on the 2nd attempt. In discussing this after the fact, I have been told to never remove the placenta before attempting replacement. What's the recommendation re placental delivery w/ uterine inversion? And in subsequent pregnancies....anything to do differently?
-- Betsy Hyde CNM Branford, CT
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