Uterine Inversion !!!!

[magz53]

Just had the evening from you-know-where. A nice delivery turned into hell with the delivery of the placenta and a uterine inversion. Mom went downhill pretty quickly. We are a rural hospital where OR and anesthesia have to be called in. She was taken to the OR in about 45 minutes where she had an emergency hysterectomy to save her life. Last I heard she was getting her sixth unit of blood. At one time her BP was 30 over zip. What a nightmare. At least she is going to live .......I guess there were a few minutes in OR when they weren't too sure she would make it. Anyone who thinks we sit around and rock babies ought to be an L + D nurse for awhile. I do not thrive on emergencies, in fact I hate them but they are always lurking even with a nice delivery........this one went sour pretty quickly. I don't know how long I can do this. My co-workers were a per diem nursery nurse who is basically clueless and a new graduate !!!!!!!! No tech, no secretary, no runner, no aide. Thanks for letting me have a place to vent where others understand. Anyone else here have experience with uterine inversion ???

[SmilingBluEyes]

What a tragic situation for the patient and horrible for you, too. I have no personal experience with this in 10 years, thank Heaven. Sounds like you did your very best......do not be too hard on yourself.

[33-weeker]

Geeez... how hard did that doc pull on the cord? I've never seen one of those and I've attended countless deliveries over 16 years.

I did see a baby coming out with the mom's cervix tight on his shoulders once, but the doc realized it and was able to use his fingers to free it and slide the baby on through it. The baby wasn't that big either. This was a young teenage mom as I recall. She did well and was very cooperative with pushing and all. I can't imagine that was comfortable for her.

[RainDreamer, BSN, RN]

All of this just because some impatient OB wanted to go to bed probably?! That makes me sick.

I'm so sorry you had to go through this. It sounds like you kept a clear head and got done what needed to be done. You did everything you could do.

[canoehead, BSN, RN]

I saw a uterine inversion once, and it was totally due to "active management" of labor. The doc manually dilated her from 6cm to fully in five minutes, with her screaming, and then pulled the baby out, and was working on the placenta. Then out comes the placenta with the uterus still attached, inside out! Doc stuffed that uterus back in faster than you could say Jiminey Cricket, and mom barely turned a hair (I swear!) But you can bet who I'll never go to if I need so much as a hangnail removed.

[Elvish, BSN, DNP, RN, NP]

It really twerks me when people manage birth like some mechanical process. It will go fine a WHOPPING majority of the time, if you will just let it.

[LizzyL&DRN]

I have never seen a uterine inversion nor have I heard of one on our unit. I have some questions about it....

Does the mom always bleed uncontrollably following it? Does she always need a hysterectomy or if you can get the uterus to relax can it be "replaced?" I see the problem in trying to get a bleeding uterus to relax so you can "turn it right side out", relaxing is the last thing you would want due to the bleeding.

On a side note: I was in a delivery just the other day and the doc pulled so hard on the cord to get the placenta out that he broke the cord. I didn't actually see it since I had my back to him, I just heard a funny noise and turned around and both the doc and the patient had blood splatter all over them. He quickly "clamped" the cord with his hand and finished pulling the placenta out. What a mess it was and the patient wasn't real thrilled. He blamed the incident on a "weak" cord. Way to take responsibility doctor!

[dawngloves, BSN, RN]

I think this is the only thing that would make me pass out at a pts bedside. And I've seen some stuff, believe me!

[magz53]

The blood loss was a large amount, but not gushing or spurting. I think it was the combo of the uterus inside out and becoming hypoxic somewhat that sent her into shock. The cervix clamped down and it was not possible to push the uterus back through it. I never want to see another one either. I want to escape a maternal death in my career....especially one that would be unneccessary. I hate all this management of a normal process. The patient now has an infection.....duh.....and is not out of the woods yet I don't think. I have seen several broken cords due to excess traction........sometimes our LDR looks like a crime scene. Can anyone tell me......what about this stuff do I like anymore ??? I am hanging on by my toenails til I can retire !!