Immediately after spontaneous delivery of the placenta, a primigravida develops sudden shock with a dark red, constricted fundus palpable above the symphysis pubis. The inverted uterus is visible at the introitus. The immediate next step in management is:
- A Attempt manual replacement of the uterus after calling for help and arranging anesthesia ✓
- B Immediate hysterectomy
- C Give oxytocin bolus before any manipulation
- D Apply the O'Sullivan hydrostatic technique as the first maneuver
Correct answer: A. Attempt manual replacement of the uterus after calling for help and arranging anesthesia
Explanation
Acute complete uterine inversion is an obstetric emergency managed by prompt manual replacement (Johnson's method), pushing the fundus through the cervix toward the umbilicus, ideally under anesthesia with uterine relaxation. Calling for help and resuscitation run parallel. Oxytocin is withheld until the uterus is replaced, since contraction makes repositioning impossible. Hydrostatic reduction is a second-line method when manual replacement fails, and hysterectomy is a last resort.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.