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A TEXTBOOK OF POSTPARTUM HEMORRHAGE - PART 3

Trở lại của tử cung vào vị trí bình thường của nó, nhau thai nên được loại bỏ bằng tay từ âm đạo, tử cung co abdominally duy trì bởi sự kích thích bi-hướng dẫn sử dụng. Ergometrine, oxytocic truyền tĩnh mạch, hoặc mesoprostyl có thể được quản lý. Vết rạch sau tử cung, nếu được sử dụng, sau đó được sửa chữa trong lớp, và vùng bụng đóng cửa trong thời trang thông thường. | Obstetric trauma Figure 1b Acute uterine inversion. Finger tips placed below fundus of uterus to facilitate reduction Figure 1d Acute uterine inversion. Return of vascularity Figure 1c Acute uterine inversion. Progressive reduction with some ischemia On return of the uterus to its normal position the placenta should be removed manually from the vagina and uterine contraction maintained abdominally by bi-manual stimulation. Ergometrine oxytocic intravenous infusion or mesoprostyl can be administered. The posterior uterine incision if used is then repaired in layers and the abdomen closed in the usual fashion. The patient should be monitored in the Figure 1e Acute uterine inversion. Complete reduction and revascularization with normal clinical features. B-Lynch technique of non-instrumental reduction of acute uterine inversion at laparotomy. Copyright 05 intensive care or the high-dependency unit for 24 h. A sub-acute inversion is managed in a similar manner but may resolve spontaneously as the uterus involutes4. 73 POSTPARTUM HEMORRHAGE In chronic inversion the uterus involutes in its inverted position and remains in the vagina as a soft swelling which bleeds readily to touch and shows areas of superficial ulceration. Prolonged inversion may result in conversion of the columnar epithelium of the uterine wall into a stratified squamous epithelium. Replacement of a chronic inversion can prove extremely difficult due partly to the inevitable edema present and the friable nature of the tissues. The techniques adopted for replacing the acutely inverted uterus are no longer helpful in this chronic situation. Bed rest elevation of the foot of the bed antibiotic prophylaxis and vaginal cleansing with hibitane packs may be helpful to reduce the edema and treat any infections but it may eventually be necessary to perform a hysterectomy. If the chronic inversion is due to the presence of a fibroid or a placental polyp initial removal of the polyp by ligating and cutting the .