Uterine Inversion

description

turning out of uterus with either birth of the fetus or placental delivery (1:20,000 births)

risk factors(spontaneous)

precipitate labor

traction on a short cord by the fetus

straining or coughing while the uterus is lax

sub mucous fundal myopia

risk factors (iatrogenic)

pressure on the fundus

traction on the cord which the uterus is lax

Types 1st degree

inverted fungus up to cervix

types 2nnd degree

body of uterus protrudes through cervix into vagina

types 3rd degree

prolapse of inverted uterus outside vulva

types 3th degree

props of inverted uterus and vagina

clinical picture (general examination)abdominal examination

cupping of the fungus——in the 1st and 2nd degree

absence of the uterus——-in the 3rd and 4th degree

clinical picture (general examination)vaginal examination

inverted uterus appears as a soft purple mass in the vagina or at the vulva 2nd & 3rd degree

Clinical picture signs and symptoms

pain in the lower abdomen

sensation of vaginal fullness with a desire to bear down after delivery of the placenta

vaginal bleeding:unless the placenta is not seperated

subacute inversion: there are minimal symptoms and condition is discovered later when the patient develops blood stained offensive vaginal discharged to infection

NUrsing actions

never attempt to replace an inversion. Handling of uterus increases bleeding

never attemp to remove attached placenta

discontinue iv line and restore fluid volume

administer oxygen by mask and monitor VS

prepare fro CPR if needed

medical management

general anesthesia or nitroglycerin/tocolytic Iv drug to relax uterus

replace funds manually

administer oxytocin after manual replacement to help uterus contract and remain in natural place

antibiotic therapy

cesarean birth in future pregnancies