Anaesthetic management of acute puerperal uterine inversion

We identified 18 cases of acute puerperal uterine inversion after vaginal delivery out of 65,581 deliveries in two university-affiliated hospitals (an incidence of 1:3643). In all cases manual repositioning of the uterus without tocolysis was attempted. In four cases this was successful. Of the 14 patients requiring tocolysis, a single dose of terbutaline 0.25 mg i.v. was tried in eight and was successful in five cases (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 endometritis. We suggest that when tocolysis is required, terbutaline should be used first because of its rapid onset of action, short duration, simplicity, availability in the labour suite and familiarity to the obstetrician, and general anaesthesia, with its inherent dangers, if possible, should be avoided.