Transvaginal manual reduction

Transvaginal hand reduction is used for the treatment of uterine bleeding. Uterine pull-out refers to the endometrial facet-out, a rare serious obstetric complication that can cause bleeding, shock, and infection. Acute uterine overturning was not detected and rescued in time, and the maternal mortality rate was very high. It usually occurs in the third stage of labor, and very few are within 24 hours after delivery. Mainly in the case of poor uterine contractions, cervical relaxation, the placenta has not been stripped by violence to pull the umbilical cord or strong pressure on the bottom of the palace. Occasionally, when the umbilical cord is too short, when the fetus is over-extended or the submucosal fibroids protrude to the outside of the cervix, the uterus is turned out. Therefore, the correct treatment of the third stage of labor is the key to preventing the uterus from turning out. Curing disease: Indication Transvaginal hand reduction is indicated for acute uterine overturning. The sooner the reset is, the better the effect. Contraindications The narrow ring formed by the cervix is tight and cannot expand. Preoperative preparation 1. Give meperidine or morphine a static pain. 2. Rehydration, blood transfusion prevention and treatment of shock. If a shock has occurred, the uterus should be covered with a sterile warm saline gauze pad while actively treating, and the operation should be performed after the general condition is improved. 3. The cervix can be tightened with 1:1000 adrenaline 0.5-1.0ml or atropine 0.5mg before the reduction to relax the cervix. Surgical procedure Uterine reduction Strictly disinfect the vulva, vagina and the uterus, and catheterize. Hold the overturned uterus with one hand, place the fingertips around the palace body, slowly and gently push up along the axis of the birth canal. When the palace body is pushed into the cervix, put the finger into the neck tube and finally turn it out. Between the parts of the palace, it is pushed gradually and gradually upwards from the surrounding area, so that the last turned out part is advanced first. At the same time, the other hand placed on the lower abdomen to help the inverted uterus completely reset. 2. Promote uterine contractions After the successful reset, the hand entering the uterine cavity is pressed against the bottom of the palace, indwelled for 3 to 5 minutes, and injected with uterine contraction agent to promote uterine contraction, reduce bleeding, and prevent the uterus from turning out again. If necessary, gauze strips can also be used to fill the uterine cavity. complication 1. Uterine injury. 2. Hemorrhagic shock. 3. Postoperative infection.