Immediately after a precipitate vaginal delivery, a multipara develops complete uterine inversion through the introitus with heavy bleeding. The placenta is still firmly attached. What is the correct immediate management?
- A Peel off the placenta first, then push the fundus back manually
- B Give intravenous oxytocin bolus and pull gently on the cord
- C Manually replace the inverted uterus with the placenta left attached, giving a uterine relaxant if needed ✓
- D Proceed directly to emergency hysterectomy
Correct answer: C. Manually replace the inverted uterus with the placenta left attached, giving a uterine relaxant if needed
Explanation
The inverted uterus must be replaced promptly, ideally within minutes, using manual pressure (Johnson maneuver) or hydrostatic replacement (O'Sullivan technique). The placenta is deliberately left attached because removing it increases hemorrhage and shock, and the attached placenta provides a surface for pushing the fundus back. If the cervix has constricted around the inversion, a relaxant such as terbutaline or halothane aids reduction. Cord traction and oxytocin before replacement worsen the inversion.
Reference: DC Dutta Textbook of Obstetrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.