The letter of Dr Criton Kasby concerning uterine inversion (O&G Magazine Volume 20 No.1 Autumn 2018) contains an important lesson for less-experienced obstetricians.
In a former life, I was a GP obstetrician delivering about 120 babies a year in a small rural centre. The woman I remember had a normal pregnancy and went into labour at term, delivering without problem or assistance. However, she continued to bleed heavily post-delivery. The uterus was palpable, very firm and seemingly very well contracted. Oxytocin did not solve the problem. The only strategy available was a large intravenous line and a rapid ambulance trip to the regional centre 60km away. There, a more experienced GP obstetrician made the correct diagnosis of partial inversion and used the hydrostatic manoeuvre described to solve the problem, no doubt saving the woman’s life.
There were many lessons from this experience, which range from the advisability of performing obstetrics in such a small centre (this practice has long since ceased in that particular location), to the diagnosis of the problem, which I had not encountered during my Diploma training, in a subsequent term overseas as a senior house officer, or in more than 1000 GP deliveries. The diagnostic clue seems to be that if the uterus seems unusually well-contracted, there is a problem. This is a message for young players.