Immediately after vaginal delivery of her first baby, a 24-year-old develops sudden severe lower abdominal pain and shock. The cervix and vagina are empty of the placenta, and a dark red congested mass with a conical tip is visible at the introitus. The cord is still attached to the placenta on the mass. What is the immediate next step?
- A Apply steady controlled cord traction to deliver the placenta
- B Give a bolus of oxytocin and attempt fundal pressure
- C Manually reposition the inverted uterus, leaving the placenta attached until reduction ✓
- D Perform immediate hysterectomy to control hemorrhage
Correct answer: C. Manually reposition the inverted uterus, leaving the placenta attached until reduction
Explanation
This is acute complete uterine inversion. Cord traction and fundal pressure worsen inversion and deepen shock, so they are forbidden. The placenta, if attached, is left in place during manual replacement (Johnson maneuver) because detaching it increases hemorrhage and delays correction. A uterine relaxant such as terbutaline or nitroglycerin aids reduction, followed by uterotonics once the uterus is restored.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.