1 / 9

An Inverted uterus and other extraordinary events

lazaro
Download Presentation

An Inverted uterus and other extraordinary events

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    2. So I was called in at 01.30…. Previous Caesarian Section Fully dilated - prolonged second stage Placenta stuck in vagina and therefore traction applied Uterus inverted into vagina Patient started to go into shock

    3. Uterine Inversion Incidence 1 in 5000 - 1 in 10,000 Clinical picture of shock, partly because of parasympathetic effect of traction on the uterine ligaments Associated with Placenta Praevia; antepartum use of MgSO4 and umbilical cord traction Usual blood loss 500 - 2500 mls Treatment: Resuscitation, Relaxation of the cervix with Mg SO4; nitroglycerine, B2 agonist General Anaesthesia

    4. There is a lot of blood around… Rushed to theatre and given a GA Uterus reverted to normal manually and with hydrostatic pressure Ergometrin given and syntocinon infusion started However: Bleeding continues And there is no sign of it stopping Uterine Atony and large vaginal tears Managed with continuous uterine massage and manual compression

    5. The night draws on…… 0230: Still compressing Everything reasonably stable but needing continued resuscitation 0330: Still compressing Everything still OK but awaiting results and feeling a bit concerned 0400: 9 units blood, 4 units FFP, + Cryo given Hb 5.7 Platelets 43 ; PT 40 APTT 100 Platelets en route from Liverpool Probably needs a central line……

    6. Coagulopathy and central lines Increased risk of haematoma? But probably not that increased Annals of surgery 1992 202 line insertions in liver transplant patients No correction of abnormalities No serious bleeding complications Low platelet counts probably most important Experienced operator if platelets < 50,000 NICE recommendations?

    7. Just what you need at 0430 Central line inserted first pass Sewing it in uneventful But now I can’t find the wire…… It must be on the tray It must be on the floor Has it been put in the sinbin? Have I lost it down the line? Nurse suggests clamping the catheter Call for the image intensifier…..

    8. Losing the guidewire Problems Dysrythmias Vascular damage Thrombosis Embolism Associated factors Inattention Inexperience Overtired staff Treatment Interventional Radiography: Gooseneck Snare Forceps Dormier basket Surgical Exploration: probably Broad Green!

    9. Hooray its still there Remove the line Leave the wire in Railroad a new cannula Replace the guidewire because this one is obviously evil Place a new CVP line Then comes the revelation…….

More Related