Immediately after a precipitate vaginal delivery, a multiparous woman develops complete uterine inversion with profuse bleeding. The placenta is still attached. The obstetrician attempts manual replacement but fails. What is the next appropriate step?
- A Apply hydrostatic reduction by instilling warm saline into the vagina under pressure ✓
- B Perform immediate hysterectomy
- C Give intravenous nitroglycerin to relax the cervix and retry manual replacement
- D Administer carboprost to contract the uterus before repositioning
Correct answer: A. Apply hydrostatic reduction by instilling warm saline into the vagina under pressure
Explanation
When manual replacement fails, hydrostatic reduction (O'Sullivan technique) uses warm saline instilled into the posterior fornix with the labia sealed around the forearm; the pressure distends the vagina and pushes the inverted fundus back. Tocolytics such as nitroglycerin may assist relaxation, but hysterectomy is reserved for refractory cases. Giving a uterotonic like carboprost before reduction worsens the constriction ring and must be avoided until the uterus is replaced.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.