Guideline for O'Sullivan's hydrostatic technique1, 2, 5
> Hydrostatic reduction is a method of correcting the inversion by infusing warm saline into the vagina
> Exclude uterine rupture before performing the procedure
> If immediate uterine replacement is unsuccessful, consider using a uterine relaxing agent such as:
> Glycereryl trinitrate spray 400 micrograms - sublingual (works within 2 minutes and has a short half life) OR
> Intravenous salbutamol up to 250 micrograms OR
> Subcutaneous terbutaline 250 micrograms (for further information see ch 101 Tocolysis for uterine hypercontractility)
> Arrange theatre to reduce / correct the inversion. Once the uterine inversion is corrected perform a manual removal of placenta if necessary
> The hydrostatic method does not always require anaesthesia and may be done in the labour and delivery room while waiting for theatre or on the way to theatre
> Position the woman in lithotomy
> Use 2 x 1 litre bags of warmed irrigation fluid (e.g. sodium chloride 0.9 %) attached to a wide bore giving set (or cystoscopy irrigation set).
> The open end of the tubing may be inserted into the vagina and the introitus sealed by holding the labia tightly around the forearm, using the other hand, to prevent the warmed fluid from leaking out (may require an assistant)
OR
> The open end of the tubing may be attached to a 6 cm silastic ventouse cup. The silastic ventouse suction cup is positioned in the lower vagina at the inner aspect of the introitus to create a seal
> Run in copious amounts of the warmed fluid by gravity or by pressure on the bag. Up to four litres may be required
> In most cases this will reduce the inversion, with rapid resolution of the shock. The placenta can then be removed under anaesthesia
> Thereafter contraction of the uterus must be maintained by appropriate oxytocic treatment top |