Sun10October0740PM 1

Are the following true of the presentation of uterine inversion?

True / False

A mass may be visible at the vaginal entrance Correct

The patient usually develops a bradycardia Incorrect answer selected

The fundus of the uterus cannot be palpated Correct

May occur during caesarean section Incorrect answer selected

Can present a week after delivery Correct

Explanation

Patients often present with a tachycardia and hypotension due to the associated blood loss but may develop a bradycardia due to the parasympathetic effect of traction on the uterine ligaments.1

Classically, a mass is usually discernable at the vaginal entrance but visibility depends upon the degree of inversion.2

Uterine inversion may present acutely, subacutely or chronically.

An inability to palpate the fundus supports the diagnosis of inversion but may be difficult in obese patients.

Excessive fundal pressure and cord traction have been linked to inversion2, especially with a short umbilical cord and a fundal placenta.3

Reference:

Beringer RM, Patteril M. Puerperal uterine inversion and shock. Br J Anaesth. 2004;92:439-41.

Abouleish E, et al. Anaesthetic management of acute puerperal uterine inversion. Br J Anaesth. 1995;75:486-7.

Grady K, Howell C, Cox C. Managing Obstetric Emergencies and Trauma: The MOET Course Manual. 2nd ed.London: RCOG Press; 2007.

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Times answered: 262