Two wide-bore intravenous lines are placed, and intravenous fluids are administered. Which of the following is the best next step in management of this patient?

Question

Two wide-bore intravenous lines are placed, and intravenous fluids are administered.  Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

11ec25c8_d994_d848_bc81_1d43e40dbcb6_MD0003_00 Uterine inversion is treated with immediate manual replacement of the uterus by placing a hand in the vagina and pushing the prolapsed uterus back through the cervix to return it to its anatomic position. Delay in reduction of the prolapse can make manual uterine replacement more difficult because the uterus can become edematous and the cervix may contract around the inverted uterus. If the placenta is still attached to the uterine wall, as in this patient, it should not be removed until after the uterus is replaced because of the risk of massive hemorrhage (Choice E). Manual replacement of the uterus requires moderate uterine relaxation; therefore, uterotonics (eg, oxytocin) are discontinued because they increase uterine tone (ie, contractility) and may make manual uterine replacement impossible to perform (Choice B). Uterine relaxants (eg, terbutaline, nitroglycerin) are typically reserved for patients in whom initial attempts at reduction are unsuccessful because such relaxants increase the risk of persistent uterine atony (ie, bogginess) and associated postpartum hemorrhage (Choice A). If attempts at manual uterine replacement fail, the next step in management is laparotomy to prevent exsanguination (Choice C). Educational objective: Uterine inversion requires discontinuation of uterotonics (eg, oxytocin) and immediate manual replacement of the uterus to prevent exsanguination. Uterine relaxants and laparotomy may be required if initial attempts at manual reduction are unsuccessful. References: Total and acute uterine inversion after delivery: a case report. (http://www.ncbi.nlm.nih.gov/pubmed/25326075) Acute complete uterine inversion after controlled cord traction of placenta following vaginal delivery: a case report. (http://www.ncbi.nlm.nih.gov/pubmed/27386133)

Two Wide-Bore Intravenous Lines Are Placed, and Intravenous Fluids Are