Uterine Inversion

Total Page：16

File Type：pdf, Size：1020Kb

Uterine Inversion Prof Khin Pyone Kyi Obstetric and Gynaecology Specialist Hospital, Nay Pyi Taw Acute inversion of the uterus Definition _Turning inside out of the fundus into the uterine cavity _Rare and serious obestetric emergency _Immediate management of shock and mannual repositioning of the uterus both reduce the morbidity and mortality Incidence _depends on geographic locationeg. 3 times higher in india than USA _decrease with active management of third stage Causes mismanagement of third stage (premature traction on umbilical cord and fundal pressure before separation of placenta) Uterine atony Fundal insertion of the morbidily adherent placenta Mannual removal of placenta Short umbilical cord Placenta praevia Connective tissue disorder( Marfan syndrome,Ehler-Danlos syndrome 50%-no risk factor, no mismanagement of third stage Classification First (Incomplete)-fundus extend to but not beyond the cervical ring Second (Incomplete)-extend beyond the cervical ring but remain within the vagina Third (complete)- extend down to the introitus Fourth Degree(Total)-vagina also inverted Symptoms Sudden cardiovascular collapse PPH and Hypovolaemic shock Severe abdominal pain Clinical presentation Signs shock is out of proportionate to Bleeding Lump in the vagina Abdominal tenderness Absence of uterine fundus per abdomen Polypoidal red mass in vagina with placenta attached Differential Diagnosis UVP Fibroid polyp Postpartum collapse Severe uterine atony Neurogenic collapse Coagulopathy Retained placenta without inversion Management Resuscitation and repositioning simultaneously Nonsurgical methods Manual replacement(Johnson method)-43-88% immediate reduction Hydrostatic method at OT( O’Sullivan method) Uterine rupture must be excluded first Placenta should be delivered only after repositioning and complete correction Uterotonic drugs Antibiotics cover Role of tocolysis In presence of cervical constriction ring Magnesium sulphate,nitroglycerine, terbutaline Adverse effect of tocolytic mediated reduction in uterine tone----- PPH Surgical methods Abdominal procedure Huntingdon’s method Haultains’ method Cervical ring is incised posteriorly with longitudinal incision Recent techniques Under laparoscopic guidance Laparotomy and silastic cup used from above Skills and Drill training .

Copy Link

Recommended publications

Case 1: Postpartum Hemorrhage Secondary to Uterine Atony
Case 1: Postpartum Hemorrhage Secondary to Uterine Atony Learning Objectives By the end of this scenario, each care team member should be able to successfully do the following: ▪ Recognize risk factors for postpartum hemorrhage. ▪ Identify postpartum hemorrhage due to uterine atony and be able to treat with appropriate medical management. ▪ Demonstrate teamwork and communication skills during a simulated postpartum hemorrhage. Planned Completion Points To successfully complete this scenario, the care team should successfully do the following: ▪ Recognize uterine atony as the etiology for postpartum hemorrhage. ▪ Perform uterine massage. ▪ Administer two different uterotonic medications. ▪ Call for blood (e.g. 2 units of PRBCs). OR Page | 1 © 2019 American College of Obstetricians and Gynecologists ▪ If 10 minutes has elapsed after recognition of hemorrhage and the team has not corrected the hemorrhage or called for blood. Expected Duration Approximately 60 minutes (30 minutes for simulation / 30 minutes for debriefing). Case Scenario Patient: Marla Smith Mrs. Marla Smith is a 38-year-old G3P2012 who was admitted in active labor at 39+3 weeks and had a spontaneous vaginal delivery 30 minutes ago. Her delivery was uncomplicated. She had a first-degree laceration that did not require repair. She is approximately 30 minutes postpartum and has just called out because she feels dizzy and has more bleeding. Patient Information ▪ She has no significant past medical history. ▪ She has no known drug allergies. ▪ Her pregnancy was uncomplicated except for an elevated 1-hour glucose screen with a normal 3- hour glucose tolerance test. Laboratory Data (On Admission): ▪ Hemoglobin: 12.2 ▪ Hematocrit: 36.6 ▪ WBC: 12,000 ▪ Platelets: 218,000 Delivery Information ▪ Measurement of cumulative blood loss (as quantitative as possible) from the delivery was 300cc.
[Show full text]
A Guide to Obstetrical Coding Production of This Document Is Made Possible by Financial Contributions from Health Canada and Provincial and Territorial Governments
ICD-10-CA | CCI A Guide to Obstetrical Coding Production of this document is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government. Unless otherwise indicated, this product uses data provided by Canada’s provinces and territories. All rights reserved. The contents of this publication may be reproduced unaltered, in whole or in part and by any means, solely for non-commercial purposes, provided that the Canadian Institute for Health Information is properly and fully acknowledged as the copyright owner. Any reproduction or use of this publication or its contents for any commercial purpose requires the prior written authorization of the Canadian Institute for Health Information. Reproduction or use that suggests endorsement by, or affiliation with, the Canadian Institute for Health Information is prohibited. For permission or information, please contact CIHI: Canadian Institute for Health Information 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: 613-241-7860 Fax: 613-241-8120 www.cihi.ca [email protected] © 2018 Canadian Institute for Health Information Cette publication est aussi disponible en français sous le titre Guide de codification des données en obstétrique. Table of contents About CIHI ................................................................................................................................. 6 Chapter 1: Introduction ..............................................................................................................
[Show full text]
Cord Prolapse
CLINICAL PRACTICE GUIDELINE CORD PROLAPSE CLINICAL PRACTICE GUIDELINE CORD PROLAPSE Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and the Clinical Strategy and Programmes Division, Health Service Executive Version: 1.0 Publication date: March 2015 Guideline No: 35 Revision date: March 2017 1 CLINICAL PRACTICE GUIDELINE CORD PROLAPSE Table of Contents 1. Revision History ................................................................................ 3 2. Key Recommendations ....................................................................... 3 3. Purpose and Scope ............................................................................ 3 4. Background and Introduction .............................................................. 4 5. Methodology ..................................................................................... 4 6. Clinical Guidelines on Cord Prolapse…… ................................................ 5 7. Hospital Equipment and Facilities ....................................................... 11 8. References ...................................................................................... 11 9. Implementation Strategy .................................................................. 14 10. Qualifying Statement ....................................................................... 14 11. Appendices ..................................................................................... 15 2 CLINICAL PRACTICE GUIDELINE CORD PROLAPSE 1. Revision History Version No.
[Show full text]
Rational Use of Uterotonic Drugs During Labour and Childbirth
Prevention and initial management of postpartum haemorrhage Rational use of uterotonic drugs during labour and childbirth Prevention and treatment of postpartum haemorrhage December 2008 Editors This manual is made possible through sup- Prevention of postpartum hemorrhage port provided to the POPPHI project by the initiative (POPPHI) Office of Health, Infectious Diseases and Nu- trition, Bureau for Global Health, US Agency for International Development, under the POPPHI Contacts terms of Subcontract No. 4-31-U-8954, under Contract No. GHS-I-00-03-00028. POPPHI is For more information or additional copies of implemented by a collaborative effort be- this brochure, please contact: tween PATH, RTI International, and Engen- Deborah Armbruster, Project Director derHealth. PATH 1800 K St., NW, Suite 800 Washington, DC 20006 Tel: 202.822.0033 Susheela M. Engelbrecht Senior Program Officer, PATH PO Box 70241 Overport Durban 4067 Tel: 27.31.2087579, Fax: 27.31.2087549 [email protected] Copyright © 2009, Program for Appropriate Tech- www.pphprevention.org nology in Health (PATH). All rights reserved. The material in this document may be freely used for educational or noncommercial purposes, provided that the material is accompanied by an acknowl- edgement line. Table of contents Preface………………………………………………………………………………………………………………………………………………….3 Supportive care during labour and childbirth…………………………………………………………………………………….4 Rational use of uterotonic drugs during labour………………………………………………………………………………...5 Indications and precautions for augmentation
[Show full text]
The Early Diagnosis and Treatment Strategy of Maternal Near Miss
Central Archives of Emergency Medicine and Critical Care Bringing Excellence in Open Access Short Communication *Corresponding author Youguo Chen, Center of Studies for Psychology and Social Development, Southwest University, 188 Shizi The Early Diagnosis and Street, Suzhou, Jiangsu, PR of China, 215006, Email: Submitted: 17 May 2016 Treatment Strategy of Maternal Accepted: 13 June 2016 Published: 14 June 2016 near Miss Copyright © 2016 Chen et al. Fangrong Shen1, Rong Jiang2, and Youguo Chen3* 1Department of Obstetrics and Gynecology, Soochow University, China OPEN ACCESS 2Laboratory of Stem Cell and Tissue Engineering, Chongqing Medical University, China 3Center of Studies for Psychology and Social Development, Southwest University, China Keywords • Maternal near miss • Early diagnosis Abstract • Management The WHO criteria for maternal near miss (MNM), defined as “a woman who nearly • Socioeconomic factors died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy”. This review mainly analyses the amniotic fluid embolism (AFE), acute fatty liver of pregnancy (AFLP), HELLP syndrome and severe preeclampsia which may lead most cases of MNM. Finally, summarize the factors and managements associated with maternal near-miss morbidity. INTRODUCTION Amniotic fluid embolism (AFE) Maternal near miss refers to someone who survived a severe Introduction: complication in pregnancy, childbirth, or the postpartum period. catastrophic obstetrics complication occurring during labor Amniotic fluid embolism (AFE) is a With the developing of our society, more and more people are and delivery or immediately postpartum, and is characterized concerned about the maternal near-miss morbidity and mortality. by sudden cardiovascular collapse, respiratory distress, altered measures to decrease the mortality of MNM-most happened They also pay attention to the scientific and effective treatment mental status and disseminated intravascular coagulation (DIC).
[Show full text]
WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage
WHO recommendations for the prevention and treatment of postpartum haemorrhage For more information, please contact: Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27 Switzerland Fax: +41 22 791 4171 E-mail: [email protected] www.who.int/reproductivehealth Maternal, Newborn, Child and Adolescent Health E-mail: [email protected] www.who.int/maternal_child_adolescent WHO recommendations for the prevention and treatment of postpartum haemorrhage WHO Library Cataloguing-in-Publication Data WHO recommendations for the prevention and treatment of postpartum haemorrhage. 1.Postpartum hemorrhage – prevention and control. 2.Postpartum hemorrhage – therapy. 3.Obstetric labor complications. 4.Guideline. I.World Health Organization. ISBN 978 92 4 154850 2 (NLM classification: WQ 330) © World Health Organization 2012 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncom- mercial distribution – should be addressed to WHO Press through the WHO web site (http://www.who.int/ about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
[Show full text]
Prophylactic Dose of Oxytocin for Uterine Atony During Caesarean Delivery: a Systematic Review
International Journal of Environmental Research and Public Health Systematic Review Prophylactic Dose of Oxytocin for Uterine Atony during Caesarean Delivery: A Systematic Review Vilda Baliuliene 1,*, Migle Vitartaite 2 and Kestutis Rimaitis 1 1 Department of Anaesthesiology, Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009 Kaunas, Lithuania; [email protected] 2 Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus str. 9, LT-44307 Kaunas, Lithuania; [email protected] * Correspondence: [email protected]; Tel.: +370-67-267569 Abstract: Objective—to overview, compare and generalize results of randomized clinical trials an- alyzing different oxytocin doses to prevent postpartum hemorrhage, initiate and maintain uterine contraction after Caesarean delivery. Methods—‘PubMed’, ‘EMBASE’, ‘CENTRAL’, and ‘CINAHL’ electronic databases were searched for clinical trials analyzing the effectiveness of different dose of oxytocin given intravenously during surgery for uterine contraction and to reduce postpartum hemorrhage. A systematic review of relevant literature sources was performed. Results—our search revealed 813 literature sources. A total of 15 randomized clinical trials, comparing different doses of oxytocin bolus and infusion used after caesarean delivery have met the selection criteria. Conclusion—oxytocin bolus 0.5–3 UI is considered an effective prophylactic dose. Recommended effective prophylactic oxytocin infusion dose is 7.72 IU/h, but it is unanswered whether we really need a prophylactic infusion of oxytocin if we choose effective bolus dose size and rate. Adverse hemodynamic effects were observed when a 5 UI oxytocin bolus was used. However, topics such Citation: Baliuliene, V.; Vitartaite, M.; as bolus dose size, infusion dose size and requirement as well as bolus injection rate, still remain Rimaitis, K.
[Show full text]
HELLP ME! Maternal Emergencies That Exist Beyond the Laboring Pregnant Patient
HELLP ME! Maternal Emergencies that Exist Beyond the Laboring Pregnant Patient Presented By: Theresa Bowden CFRN, CCRN, C-NPT Life Flight Network Maternal Emergencies • Hypertensive Disorders of Pregnancy – Preeclampsia, Eclampsia, Gestational Hypertension, Chronic Hypertension • HELLP Syndrome • Amniotic Fluid Embolism • Ante/Postpartum Bleeding • Pregnancy and Trauma Pre-Eclampsia • Defined as: – New onset of hypertension and either proteinuria OR end-organ dysfunction OR both after 20 weeks of gestation in a previously normotensive woman. – * Edema not longer required for this diagnosis. – Can be classified as Mild or Severe Mild Pre-Eclampsia • Blood pressure >140/90 • >300 mg/dL Protein in a 24 hour urine collection Severe Pre-Eclampsia • SBP > 160 or DBP >110 (? recorded on 2 occasions, 6 hours apart) • Proteinuria • ? Oliguria • Visual disturbances • Epigastric pain; Nausea & vomiting • Pulmonary edema • HELLP syndrome • ? Fetal growth restriction Eclampsia • Defined as: – The development of grand mal seizures in a woman with preeclampsia (in the absence of other neurologic conditions that could account for the seizure). Gestational Hypertension • Defined as: – Hypertension without proteinuria or other signs/symptoms of preeclampsia that develops after 20 weeks of gestation. – It should resolve by 12 weeks postpartum. Chronic Hypertension • Defined as: – Chronic/preexisting hypertension is defined as systolic pressure ≥ 140 mmHg AND/OR diastolic pressure ≥ 90 mmHg that antedates pregnancy – OR is present before the 20th week of pregnancy (on 2 occasions) – OR persists longer than 12 weeks postpartum. Complications • Placental abruption • Acute kidney injury • Cerebral hemorrhage • Hepatic failure/rupture • Pulmonary edema • DIC (disseminated intravascular coagulation) • Progression to eclampsia Mortality • In the United States, preeclampsia/eclampsia is one of four leading causes of maternal death – Hemorrhage – Cardiovascular conditions – Thromboembolism – Preeclampsia/eclampsia 1:100,000 live births results in maternal death due to preeclampsia.
[Show full text]
ANMC Obstetric Hemorrhage Guidelines
ANMC Obstetric Hemorrhage Guidelines ANMC Obstetric Hemorrhage Guideline Content Page Background 2 Differential Diagnosis of Postpartum Hemorrhage 3 Obstetrical Hemorrhage Intervention Strategies 4 Post-partum Hemorrhage Response Algorithms 6 Post PPH Stabilization 9 Appendices: Appendix I: Iron therapy in pregnancy flow cart 10 Appendix II: PPH Risk Assessment Tool 11 Appendix III: QBL tool 12 Appendix IV: L&D Stat Team 13 Appendix V: PPH medication kit 14 Appendix VI: PPH Cart 15 Appendix VII: PPH Instrument Tray 16 Appendix VIII: PPH flow sheet 17 Appendix IX: Blood product guide 18 Appendix X: Surgical options for PPH 19 Appendix XI: Quality review document 21 Appendix XII: PPH Response Algorithm Checklist 23 Appendix XIII: PPH prefilled consent forms 24 Appendix XIV: Debrief tool 25 Revised: 4/6/18 rsg Revised 11/26/17rsg Revised 2/19/14sjh/njm Revised 5/19/11njm 1 ANMC Obstetric Hemorrhage Guidelines ANMC Obstetric Hemorrhage Guideline Background The definition of early postpartum hemorrhage (PPH) is “Cumulative blood loss of >1000ml accompanied by signs/symptoms of hypovolemia within 24h following the birth process”. PPH is an increasing cause of maternal morbidity and mortality. It accounts for 30% of all maternal deaths worldwide and 10% of maternal deaths in the U.S. The rate of postpartum hemorrhage is steadily increasing throughout developed countries including the U.S. Between 1994 and 2006, pregnancy- related hemorrhage in the U.S. has increased 26-27% and is now the leading cause of maternal death. The most common etiology for PPH (≈70-80%) is uterine atony, or a soft, non-contracted uterus.
[Show full text]
Surgical Management of Miscarriage and Removal of Persistent Placental Or Fetal Remains
Surgical Management of Miscarriage and Removal of Persistent Placental or Fetal Remains Consen t Advice No. 10 (Joint with AEPU) January 2018 Surgical Management of Miscarriage and Removal of Persistent Placental or Fetal Remains This is the second edition of this guidance, which was published in 2010 under the title Surgical Evacuation of the Uterus for Early Pregnancy Loss . This paper provides advice for health professionals obtaining consent from women undergoing surgical management of miscarriage with electric or manual vacuum aspiration. It is also intended to be appropriate when surgical intervention is indicated for an incomplete termination of pregnancy, incomplete or delayed miscarriage, or partially retained placenta after delivery. After careful discussion with the woman, the consent form should be edited under the heading ‘Name of proposed procedure or course of treatment’ to accurately describe the exact procedure to be performed. The paper follows the structure of Consent Form 1 from the Department of Health, England 1/Welsh Assembly Government 2/Department of Health, Social Services and Public Safety, Northern Ireland. 3 It should be used as part of the consent process outlined in the Royal College of Obstetricians and Gynaecologists (RCOG) website at rcog.org.uk/consent, and in conjunction with the RCOG Clinical Governance Advice No. 6 Obtaining Valid Consent 4 and Clinical Governance Advice No. 7 Presenting Information on Risk. 5 Please also refer to the National Institute for Health and Care Excellence (NICE) clinical guideline 154 Ectopic pregnancy and miscarriage: diagnosis and initial management. 6 The aim of this advice is to ensure that all women are given consistent and adequate information for consent.
[Show full text]
Management of Miscarriage and Early 2Nd Trimester Intrauterine Fetal Demise
1/31/19 SJH Management of Miscarriage and Early 2nd Trimester Intrauterine Fetal Demise Summary & Recommended Management: Overview SAB = approx. 25% of pregnancies Most common 1st tri complication 50% chromosomal Unlikely to be recurrent Usually unexplained and not preventable Modifiable RF: tobacco and substance cessation, folate supplementation, optimization of chronic medical conditions (e.g. improved BG control in DM) Options Expectant, medical, and surgical Hemorrhage and infection rates low for all groups No difference in future birth rates Expectant >80% will complete w expectant management alone May require follow up for 4wks or more to complete Antibiotics not needed Success with completion likely decreasing with increasing GA, especially beyond 8wks Medical Up to 90% success w medical management Ideal dose not known, misoprostol 800mcg PV or buccal may be the most efficient Mifepristone 200mg PO 24hrs before misoprostol administration should be considered if available An additional 800mcg misoprostol dose may be repeated 3hrs to 7days after initial misoprostol Increased success with higher misoprostol doses, more time, and lower GA Antibiotics not needed Confirmation of complete SAB may be a clinical diagnosis, no clear US criteria exist Surgical Successful >99%, immediate resolution D+C <14wks, D+E >/=14wks GA US assist intraoperatively may help if: anomalies, challenging dilation, perforation suspected, concern about incomplete procedure, later GA US recommended at D+E, especially for less-experienced
[Show full text]
Risk Factors for Severe Postpartum Hemorrhage: a Case-Control Study
Nyfløt et al. BMC Pregnancy and Childbirth (2017) 17:17 DOI 10.1186/s12884-016-1217-0 RESEARCHARTICLE Open Access Risk factors for severe postpartum hemorrhage: a case-control study Lill Trine Nyfløt1,2,3*, Irene Sandven4, Babill Stray-Pedersen2, Silje Pettersen1, Iqbal Al-Zirqi1, Margit Rosenberg3, Anne Flem Jacobsen1,2 and Siri Vangen2,5 Abstract Background: In high-income countries, the incidence of severe postpartum hemorrhage (PPH) has increased. This has important public health relevance because severe PPH is a leading cause of major maternal morbidity. However, few studies have identified risk factors for severe PPH within a contemporary obstetric cohort. Methods: We performed a case-control study to identify risk factors for severe PPH among a cohort of women who delivered at one of three hospitals in Norway between 2008 and 2011. A case (severe PPH) was classified by an estimated blood loss ≥1500 mL or the need for blood transfusion for excessive postpartum bleeding. Using logistic regression, we applied a pragmatic strategy to identify independent risk factors for severe PPH. Results: Among a total of 43,105 deliveries occurring between 2008 and 2011, we identified 1064 cases and 2059 random controls. The frequency of severe PPH was 2.5% (95% confidence interval (CI): 2.32–2.62). The most common etiologies for severe PPH were uterine atony (60%) and placental complications (36%). The strongest risk factors were a history of severe PPH (adjusted OR (aOR) = 8.97, 95% CI: 5.25–15.33), anticoagulant medication (aOR = 4.79, 95% CI: 2.72–8.41), anemia at booking (aOR = 4.27, 95% CI: 2.79–6.54), severe pre-eclampsia or HELLP syndrome (aOR = 3.03, 95% CI: 1.74–5.27), uterine fibromas (aOR = 2.71, 95% CI: 1.69–4.35), multiple pregnancy (aOR = 2.11, 95% CI: 1.39–3.22) and assisted reproductive technologies (aOR = 1.88, 95% CI: 1.33–2.65).
[Show full text]