Uterine inversion
This is a profoundly shocking (both by blood loss and parasympathetic outflow) complication of excessive cord traction, on a fundally sited placenta, where the uterus is atonic. The inversion should be reduced (if able to before contractions) even if placenta still attached, and then maintained with IMI ergometrine followed by syntocinon infusion.
Resuscitation may be required, including pain relief. If the inversion cannot be reversed, one method is to hold the body of the uterus in the vagina while rapidly infusing into it two litres of warm saline with a urology irrigation set. While effective, unless performed by experienced staff, expeditious transfer is faster.
Amniotic fluid embolism
While rare, when this occurs mortality is ~80%, so that this is a significant cause of all maternal deaths. Usually it follows rapid labours with hypertonic uterine activity, or pregnancies complicated by excessive liquor. It is also reported following stimulation of the fundus prior to full separation of the placenta. It should be considered in any woman who collapses during or immediately after labour for no apparent reason.
Expect profound shock, cyanosis, dyspnoea, and DIC, and resuscitate aggressively, including intubation if necessary. Collect blood for coags and fetal squames, then give IV heparin 10,000U and hydrocortisone 1g while awaiting transfer.
cf: Amniotic Fluid Embolism
Sue Page is a general practioner obstetrician in Lennox Head, NSW, Australia.
This page was last built on 10/01/03. It was originally posted on 3/5/98; 7:46:04 PM.
