A 26-year-old G2P2 delivers vaginally. Immediately after delivery of the placenta, she complains of severe lower abdominal pain and sudden onset dizziness. On examination, the uterine fundus is not palpable abdominally, and a dark red mass is visible at the vaginal introitus. Her heart rate is 120 bpm and blood pressure is 80/50 mmHg. What is the most appropriate immediate management?

• A Manual removal of the placenta under anesthesia
• B Immediate laparotomy to correct the inversion
• C Intravenous infusion of high-dose oxytocin
• D Hydrostatic reduction using O'Sullivan's method ✓

Explanation

The clinical picture of a non-palpable uterine fundus with a dark red vaginal mass and shock is classic for acute uterine inversion. The most appropriate immediate management is hydrostatic reduction using O'Sullivan's method, which uses warm saline pressure to gently push the uterus back into place. Oxytocin is contraindicated because it can worsen the constriction ring, making reduction harder. Manual removal is for retained placenta, and laparotomy is reserved for cases where hydrostatic reduction fails.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.