Complex Partial Bowel Transfer

The case

Uterine inversion means the uterus has turned inside out after the baby is born, usually while the placenta is coming out. The top of the uterus drops down into the vagina, and in a full inversion it comes out through the vaginal opening. It is linked to a uterus that does not tighten well, which is more likely after many births, and to strong pulling on the cord or pressing on the top of the belly while the placenta is being delivered. It usually causes strong pain, a feeling that something is coming down, and bleeding that can be heavy and can quickly lead to shock.

The uterus is put back as soon as possible. With time, the ring of the cervix around it tightens and the uterus swells with blood, which makes it harder to put back. Most often it is done from below, by hand: the uterus is pushed gently back up through the cervix. If that does not work, warm water is run into the vagina so the water pressure stretches the vagina and the cervix and lets the uterus go back. If that does not work either, the hand method is tried again under general anesthesia, which relaxes the uterus. Rarely, an operation through the belly is needed.

The woman has a drip in a vein, and a blood transfusion if she has lost a lot of blood. She gets strong pain medicine and sedation, or a general anesthetic, and a tube (catheter) in the bladder. Medicine to make the uterus contract is held until the uterus is back in place, then given to keep it there and to slow the bleeding. One dose of antibiotic is given. If the placenta is still attached, it is removed by hand after the uterus is back. She is then watched closely for bleeding and for fever.