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OB: Inverted uterusFrom: John Robertson M.D. (john.robertson@obgyn.net)Sat Mar 13 09:01:12 1999
Just a few questions about a case I had this week 37yo G1P0 followed by my self and her G.P. for Gestational Diabetes (diet controlled). No other risk factors, otherwise normal pregnancy. Induced at term because of slight concerns about increasing glucose levels and increasing B.P. Induction started by myself in a.m. with 2mg pg gel. Assessed throught the a.m. and early p.m. ARM performed at approx. 15:30, light mec staining - clip applied because of difficulties auscultating externally. Progress was slow and by 20:30 was still only 3cm. Syntocinon augmentation called for, but patient's contractions picked up shortly after order for syntocinon (murphy's law), so none given. At 22:00 patient was 6 cm and I handed back to the G.P. for monitoring and delivery. At 2 am I got a call from the G.P. - curious tone of voice more than concerned - with delivery of the placenta "something else" came out as well - not a succenturate lobe, not a bilobed placenta, "looks like another placenta only it's larger, it's on a thick stalk, and it won't come out". On my way to check this out I am going over the words in my mind. Half way there I realize the only thing it can be is an inverted uterus. Sure enough when I arrive - there it is on the bed! Called for the anaesthetic team, and started to replace the uterus. Got it back in in under 10 minutes - before the team could arrive. Significant resussitation required including 2 units PRBC. Hb day 2 was 76. Patient and baby are both well. I will spare you the comments I heard about home deliveries Questions: 1) How often have people seen this in primips - I have only had 2 in practice so far and they have both been in primips. 2) All present at the delivery deny there was significant traction on the cord. How often have you seen this without identifiable risk factors at delivery? 3) What would you qoute for recurrence risk? 4) Appart from awareness, vigilance, and basically hands off the placenta and cord - what else would you recommend in any future pregnancy/delivery? 5) Any other comments? John
-- J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9, Canada (604) 793-9988 e-mail john.robertson@obgyn.net Who is wise and understanding among you? Let him show it by his good life, by deeds done in the humility that comes from wisdom. James 3 vs 13, NIV
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