Obstetric and Gynecological Nursing - The Carter Center

Management
Pressure is applied first to the part nearest the cervix, working
up wards to the fundus on the principle of “last out, first in”. No
attempt is made to remove the placenta until the uterus is the
right way out, otherwise hemorrhage can not be controlled. If
reinvasions not promptly performed, blood loss may be rapid
and extreme, resulting in hypovolemic shock.
An inverted uterus can not contract and retract. Urgent
assistance must be summoned mean while.
If replacement of a totally inverted uterus is not possible it
should be gently placed inside the vagina to relieve traction on
the ovaries and fallopian tube. When the uterus is
successfully replaced, oxytocin is administered to stimulate
uterine tone and avoid recurring inversion. Raising the foot of
bed will also help to relieve the tension and alleviate shock.
Hydrostatic pressure method - several litres of warm saline or
interavenous solution are run into the vagina via a douche
nozzle head in the posterior fornix. The operator's forearm
effectively seals the vaginal out let. As the fluid pressure with
in the vagina rises, the uterus returns to its normal position.
Intravenous ergometrine 0.25 mg should be given to secure a
good contraction before the hand is with drawn. Antibiotic
278