Now, we're ready for the second complication, and this one also involves the uterus.
It's called a uterine inversion.
So in this condition, the uterus which is normally inside the body actually turns inside out
and sometimes it comes all the way outside the body.
How do we notice that someone has experienced the uterine inversion?
Well, when we go to palpate the uterus, which is part of our normal postpartum assessment,
it won't be palpable, you won't be able to feel it,
or it won't have that nice round shape that the fundus usually has. It'll feel more like a W.
Sometimes, you might find that the client complains of feeling lots of pressure in the vagina
and that's because the uterus might be in the vagina, also not good.
There may be a time when the uterus has extruded so much that you pull back the sheets
and you actually see it, so that would be a uterine inversion.
And, finally, given the complications that occur when someone experiences an inversion,
the signs of shock may become present, and definitely you'll notice that.
What are the risk factors?
Vigorous uterine massage. So, I want you to watch this graphic.
So what you see are some hands that are massaging the uterus, watch what happens.
Oh, my, goodness. The uterus has actually come out.
So this is one of the reasons why we guard the lower uterine segment,
so if that uterus begins to slip down, we can see it and stop what we're doing.
Another thing that may lead to uterine inversion is excessive traction on the cord.
Think about 3rd stage, when we're guiding gently the placenta as it comes out and it's delivered.
Well, if we pull too hard, then we can actually pull the placenta
which is still attached to the uterus all out at the same time.
So gentle traction is very important.
If the umbilical cord is particularly short, then it may increase the chances that we might actually,
again, pull the cord attached to the placenta, still attached to the uterine wall,
and they all come out together.
If there's been a prolonged labor, the uterus is a muscle and it gets really worn out
and its ability to support itself can actually be affected by that.
So a patient who experienced a really long, really tough labor,
may also be at increased risk for uterine inversion.
So how do we make the diagnosis of uterine inversion?
Well, physical assessment. This is either feeling, or in some cases not feeling the uterus.
The provider can also come in and perform an ultrasound,
and we can look and figure out exactly where the uterus might be located.
What is the nurses responsibility in a uterine inversion?
If the provider is not already there, we need to make a call and let them know.
Likely, they're going to be the ones that have to reinvert the uterus,
so go ahead and get that started.
If there's oxytocin running, remember what it does. Oxytocin causes contractions.
We certainly don't want to have contractions on a uterus that is not in the right place.
that is exactly the opposite of what we would want.
We want to insert an indwelling catheter into the bladder and the reason for this is really obvious.
If we have an extended or distended bladder,
because its full, we want to empty it and create space inside the pelvic cavity for the uterus.
We'll start an IV. In case the client does go into shock,
we need to make sure we have fluids so that we can counteract that.
The nurse should be prepared to assist with the uterine replacement.
You can see that in this graphic. After a vigorous uterine massage,
the uterus inverts, and then it is replaced.
As simple as that looks, it needs to be done by somebody who really knows what they're doing,
otherwise, shock can be the complication.
Now given the fact that someone is doing that particular procedure,
having anesthesia close by might be really important.
We want the client to be nice and relaxed, and that is not a relaxing procedure.
Sometimes, if there's excessive bleeding that occurs, then labs might be required,
so being ready for that would be really important for the nurse.