30 Something Baby Doc

The resident tried to reposition the uterus but it wouldn't budge and the patient was continuing to bleed. We rushed the patient back to the operating room in order to stabilize her and make her comfortable while we were figuring out how to get the uterus back in place. Repositioning the uterus quickly is the goal because the longer you wait, the more likely the uterus starts to contract (clamp down) making nearly impossible to get it back in it's correct place.

When we got the patient to the OR I looked under the sheets and saw that the bed was soaked with blood. The patient had lost almost another liter of blood on the way back to the OR (Oh Shit!) Some text books recommend giving tocolytics (medications that help relax the womb) to aid in repositioning the uterus but sometime the prolonged effects of these drugs can make the blood loss worse.

The anesthesiologist sedated the patient and was preparing to give nitroglycerine to help relax the uterus. I told them I would make another attempt to reposition the uterus by hand. If that failed then we would have to surgically open the patients belly and reposition the womb by making an incision the the backside to create slack. That would mean more bleeding (what joy).

I placed my right hand in the patient's vagina and my left hand on the patients belly. I felt the firm mass in the vagina that was the womb turned inside out. I pushed against this mass as hard as I could. It was like pushing against petrified dough. The patient started screaming (obviously she needed more sedation). I started to feel the inverted uterus begin to give way and return to it's normal position. I kept pushing until my right arm was buried in the patients vagina up to my elbow. I began to feel something wet on my arm and realized that blood was soaking through my gown. After much effort the uterus was back in it's correct position. I felt the uterus start to clamp down on my arm (which is a very good thing). The bleeding abruptly stopped.

I'm not sure what made the patient happier, her womb being returned to it's correct position or the fact I had removed my entire arm from her vagina.The patient and her baby did very well.

I think I've met my quota for blood loss this year.










repositioning of the uterus