UTERINE INVERSION

• Risk factors: multiparity, placenta accreta, short umbilical cord
• Can cause rapid severe maternal hemorrhage
• Treatment:
  • Manual replacement of the uterus ("Johnson maneuver")--May be difficult if uterus becomes entrapped in the cervical ring; if so, general anesthesia or incision of the contracted cervical ring may be required.  May also use nitroglycerin (SL, spray, or IV).
  • Tocolytics
  • Fluid and/or blood replacement