ANESTHETIC MANAGEMENT OF ACUTE PUERPERAL UTERINE INVERSION

We identified 18 cases of acute puerperal uterine inversion after vagi nal delivery out of 65 581 deliveries in two university-affiliated hos pitals (an incidence of 1:3643). In all cases manual repositioning of the uterus without tocolysis was attempted. In four cases this was suc cessful. Of the 14 patients requiring tocolysis, a single dose of terb utaline 0.25 mg i.v. was tried in eight and was successful in five cas es (success rate of 63%), while in three patients general anaesthesia was required. In six other patients, general anaesthesia was chosen as the initial management. There was no associated maternal mortality or morbidity with the exception of one case of acute postpartum endometr itis. We suggest that when tocolysis is required, terbutaline should b e used first because of its rapid onset of action, short duration, sim plicity, availability in the labour suite and familiarity to the obste trician, and general anaesthesia, with its inherent dangers, if possib le, should be avoided.