NHS FORTH VALLEY

Management of Acute Inversion of

Uterus

Approved
Version
Date of First Issue
Review Date
Date of Issue
EQIA
Author / Contact

03/04/2015
1.1
03/04/2006
03/04/2017
03/04/2015
Yes
Debbie Forbes

Group / Committee
Final Approval

Unit Clinical Governance

03/04/2015

This document can, on request, be made available in alternative formats

Version 1.1

3rd April 2015

UNCONTROLLED WHEN PRINTED

Page 1 of 5

NHS Forth Valley

Consultation and Change Record

Contributing Authors:

Consultation Process:
Distribution:
Change Record

Dr P Holmes
Obstetric Consultants, Team Leaders, SoMs & Midwives
Obstetric Consultants, Team Leaders, SoMs & Midwives

1) Updated References
2) Add Ensure Early Involvement of Multidisciplinary Team

Version 1.1

3rd April 2015

UNCONTROLLED WHEN PRINTED

Page 2 of 5

NHS Forth Valley

Women & Childrens Unit
Management of Acute Inversion of Uterus

Treatment involves prompt and immediate replacement of the inversion

Maternal shock due to vasovagal response will increase and may become irreversible
(Grady et al 2007)
EMERGENCY CALL FOR HELP - 2222
Experienced Midwife
Middle Grade Doctor, SHO & Consultant Obstetrician,
Obstetric Anaesthetist & ODP
Be ready to transfer to theatre

Call for medical

assistance

Resuscitate
A.B.C.
observe for signs of
shock

RESUSCITATION
AIRWAY ASSESS AIRWAY
Secure and maintain airway
If placenta in situ
Leave

BREATHING ASSESS BREATHING

Oxygen therapy, 15 litres by non-rebreathing mask
CIRCULATION
IV Access cannula x 2 (16G grey) or as large a cannula as possible
Take blood for X Match 4-6 units, FBC and Clotting Screen
Commence infusion of Hartmanns
MONITOR
Continuous pulse and blood pressure recording (using oximeter and automated BP
recording)
All observations recorded on Early Warning Score Chart
Observe woman for signs of shock
Blood loss

If placenta adherent - LEAVE removing may cause MASSIVE

HAEMORRHAGE
Manual replacement of uterus should be undertaken with great care to avoid
TRAUMA
Replacement should be attempted immediately by pushing the uterine fundus with a
fisted hand along the axis of the vagina through the cervix and into the vagina. This
often effects a rapid reduction in early stage and may require no additional analgesia.
Maintain this position for 3 5 minutes
Subcutaneous Terbutaline 250 micrograms may be given to relax cervical ring to
facilitate replacement

Version 1.1

3rd April 2015

UNCONTROLLED WHEN PRINTED

Page 3 of 5

Manual Replacement
of Uterus should be
Attempted
Immediately

Commence IV fluids
Take bloods
Monitor Vital Signs

Hydrostatic
Replacement of
Uterus

Prepare for Theatre if

Unsuccessful

NHS Forth Valley

Women & Childrens Unit
Management of Acute Inversion of Uterus

Prepare oxytocin infusion 30 units Syntocinon in 500 mls 0.9% Sodium Chloride at
125mls/hr to give when uterus replaced
Hydrostatic technique may be performed by an obstetrician by using the following techniques
DO NOT PERFORM IF UTERINE RUPTURE SUSPECTED:

3 litres of uromatic saline (Heated lotion cupboard in Maternity Theatre) & connect to TUR
set (kept in theatre prep area)

Or use 4 giving sets each attached to a litre bag of 0.9% Saline. Place end of giving set
between two fingers and seal vagina with knuckle of the hand

Or use a ventouse silicone cup attached to an IV giving set & a litre bag of fluid (cut the
end off the IV giving set & attach to a No 3 neonatal ET tube connector then fit the
ventouse tube to the large end of ET connector. A pressure infuser will improve the flow
of fluid. The ET tube connector is labelled in a plastic bag in the prep area of theatre
ready for use
IF NO SUCCESS SURGERY WILL BE REQUIRED

Reference
Grady K ,Howell C, Cox C (2007) Managing Obstetric Emergencies and Trauma, The Moet Course
Manual RCOG Press London
THISTLE Study 2013 PROMPT Course Manual Cambridge University Press

April 2015: Review April 2017 or sooner D Forbes/Dr P Holmes

Version 1.1

3rd April 2015

UNCONTROLLED WHEN PRINTED

Page 4 of 5

Prepare
Oxytocin
Infusion

Publications in Alternative Formats

NHS Forth Valley is happy to consider requests for publications in other language or formats such as
large print.
To request another language for a patient, please contact 01786 434784.
For other formats contact 01324 590886,
text 07990 690605,
fax 01324 590867 or
e-mail - fv-uhb.nhsfv-alternativeformats@nhs.net

Version 1.1

3rd April 2015

UNCONTROLLED WHEN PRINTED

Page 5 of 5