Immediately after vaginal delivery of a second twin, the complete uterus suddenly appears outside the introitus with the placenta still attached. The patient is shocked out of proportion to visible blood loss. After calling for help and starting resuscitation, the initial specific maneuver for replacing the uterus is:

• A Immediate manual removal of the placenta before any attempt at repositioning
• B Application of fundal pressure from above while pulling the cord
• C Emergency laparotomy with hysterectomy
• D O'Sullivan hydrostatic reduction using warm saline instilled into the vagina ✓

Explanation

Acute complete uterine inversion is replaced by manual repositioning (Johnson maneuver), and when that fails, O'Sullivan hydrostatic reduction, in which warm saline is instilled under pressure into the vagina to distend it and push the fundus back. The placenta should be left attached until the uterus is replaced, because removing it first worsens bleeding. Fundal pressure and cord traction caused the inversion and must never be repeated. Laparotomy with halving or Huntington correction is reserved for failed vaginal methods.

Reference: Munro Kerr's Operative Obstetrics, 13th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.