Vol. 20 No 1 | Autumn 2018
Uterine inversion
A/Prof Criton Kasby

This article is 6 years old and may no longer reflect current clinical practice.

I write in regard to an article on the treatment of uterine inversion (O&G Magazine, Winter 2017). I have personally experienced this problem on three occasions during my training in the UK and can testify to the effectiveness of the hydrostatic approach, which was successful on the two occasions I used it.

The first experience I had with this problem unfortunately had a fatal outcome. As a Senior House Officer in 1974, I was the obstetric arm of a flying squad to a peripheral unit 45 minutes drive from Salisbury. Following an instrumental birth, a young primigravid woman collapsed for no obvious reason without excessive blood loss. Examination in less than ideal circumstances showed a firm contracted uterus and minimal ongoing vaginal blood loss. Despite vigorous attempts to revive her, she died following transfer to the main unit with a presumptive diagnosis of amniotic fluid embolism. The autopsy demonstrated a partial inversion with the uterine fundus just protruding through the dilated cervical os. This was a salutary lesson for a junior trainee.

Two subsequent and obvious cases were treated expeditiously using the hydrostatic technique. This was performed simply by returning the inverted uterus into the vagina, cupping both hands to occlude the vaginal introitus and inserting a wide-bore tube in the space between the overlapping thumbs and forefingers. Warm liquid from a canister under hydrostatic pressure was enough to distend the vagina and cervical ring to allow the inverted uterus to be relocated successfully.

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