Prevention:
1) Donot employ any method to expel the placenta out when the uterus is relaxed.
2) Pulling the cord simultaneous with fundal pressure should be avoided.
Management:
Immediate replacement without attempting to remove the placenta from the inverted fundus.
Indications for removing the placenta before replacement of the uterus:
If placenta got separated already.
If very big size placenta obstructing the replacement.
Principle steps in manual replacement:
1)Replace that part which is inverted last.
2) Apply counter support.
3) After replacement the hand should remain inside the uterus until uterus becomes contracted by iv oxytocin or PGF2a.
If shock developes:
1) Immediate resuscitation must be started with IV fluids and cross matched blood.
2) On no account should ergometrine or oxytocins be given before replacement as these will only aggravate matters and make reduction or replacement of uterus more difficult.
Replacement of Uterus:
The longer the time the more difficult is to replacement because of constriction of cervical ring.
1) Manual reposition
2) Hydrostatic reduction or Osullivan's method, if the above method fails because of too tight cervical ring, need to be relaxed by tocolytics or general anesthesia.
1) Donot employ any method to expel the placenta out when the uterus is relaxed.
2) Pulling the cord simultaneous with fundal pressure should be avoided.
Management:
Immediate replacement without attempting to remove the placenta from the inverted fundus.
Indications for removing the placenta before replacement of the uterus:
If placenta got separated already.
If very big size placenta obstructing the replacement.
Principle steps in manual replacement:
1)Replace that part which is inverted last.
2) Apply counter support.
3) After replacement the hand should remain inside the uterus until uterus becomes contracted by iv oxytocin or PGF2a.
If shock developes:
1) Immediate resuscitation must be started with IV fluids and cross matched blood.
2) On no account should ergometrine or oxytocins be given before replacement as these will only aggravate matters and make reduction or replacement of uterus more difficult.
Replacement of Uterus:
The longer the time the more difficult is to replacement because of constriction of cervical ring.
1) Manual reposition
2) Hydrostatic reduction or Osullivan's method, if the above method fails because of too tight cervical ring, need to be relaxed by tocolytics or general anesthesia.
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