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Re: OB: Inverted uterusFrom: Anna Meenan, MD (annam@uic.edu)Mon Mar 15 11:20:34 1999
At Sat, 13 Mar 1999, John Robertson M.D. wrote: > >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 > Interesting discussion. Some very personal perspectives: In 1983 I was GIP0 and birthed a 10-lb. baby after a three-hour second stage. Placenta delivered quickly and was LARGE. We have videotape documentation that the doc was not pulling on the cord at all, but darned if I didn't invert. What struck me immediately was that something was wrong because I had not seen my own patients experience this much pain right after the placenta comes out. My next thought was that it must be an inversion and GOD, DID IT HURT! One of my least favorite consultants hurried in to fix me up and ordered 50 mg of meperidine IV, which snowed me completely but, interestingly enough did nothing for the pain at all. An anethesiologist knocked me out just in time (one of the reasons the consultant was not a favorite of mine was big hands that he was very rough with when inside a uterus). We all survived, and before I had my next two babies (both sans inversion) I did a lot of reading and found everything from minimal risk of future inversions to "don't ever have another baby". In spite of the fact that I became much more supportive of home birth before the second two were born, I decided it was not for me with that history. The only precautions we took were to have a heplock in place before second stage began and no cord traction. The second two babies were 7 and 8-pounders, so I think that helped.
-- Anna L. Meenen, MD, FAAFP
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