Displacement of Uterus

DISPLACEMENT
OF UTERUS
Amandeep kaur
M .sc nusing 1st year
Roll no 2
INTRODUCTION
 Uterine displacement is the
disorder in which sideways,
backward, or downward
malposition of the uterus may
occur
 There are three types of uterine
displacement that are certain to
cause physical distress. These are
 Retroversion
 Uterus prolapse
 Uterine inversion
 Retroversion of the uterus
it mean that the axis of the

cervix become behind the
vertical axis of female
body.
 Retoflexion
axis of the uterine body
become behind the axis of 1.Retroflexio
female body. n
2.Retroversi
on
3.Normal
CAUSES OF RETROVERSION
& RETRO-FLEXION
 Acquired during L&D
1-Bearing down
2- Forceps delivery
3-breach extraction
before full dilatation
CAUSES OF RETROVERSION &
RETRO -FLEXION
 During puerperium
No kegle’s exercise
 Heavy Uterus- fibroid
subinvolution
 Lax ligament -
pregnancy
 Adhesion - inflammation
SYMPTOMS
1. Pain
2. low backache
3. Dysmenorrhea
4. Dysparunia
5. Mid cyclic pain
6. Menstrual disturbance
SIGNS
1. Cervix is displaced
2. Absent of the uterus

interiorly
INVESTIGATION
PV Examination- fied or mobile
uterus
Hysterography- position of the uterus
COMPLICATION
1. Kinking of the uterine vessels-
Dysmenorrhea, menorrhagia
2. Congestion of the ovary
Polymenorrhra, mid cyclic pain
3. Infertility
Anovulation
 Uterine prolapse
 Prolapse of tube & ovaries
MANAGEMENT
 Prophylactic
1. During labor
Avoid bearing down
Avoid breach extraction before full

dilatation of the cervix
2. During puerperium
Hodge pessary
MANAGEMENT
 Bladder drainage by
indwelling catheter
 Patient positioning
exercises (e.g.
intermittent knee-chest
or all-fours positioning,
sleeping prone)
MANAGEMENT
 Surgical exploration and replacement
 Specialized and rarely attempted techniques
of replacement (e.g. employment of a
mercury-filled Voorhees bag in the vagina)
PROLAPSE OF THE UTERUS
UTERINE PROLAPSE
 Prolapse of the uterus refers to the

downward displacement of the vagina and
uterus.
CAUSES
1.Congenital
Congenital prolapse - At birth
2.Acquired - Labour
1-Bearing down
2-Forceps delivery
3-Breach extraction before fully
dilatation
4-Large head without episiotomy
5-Traction on cord
6-Prolonged labour
CAUSES
 During puerperium
No kegle’s exercise
Lack of exercise and bodily

weaknes
Repeated deliveries and manual

work.
 heavy uterus- fibroid, sub
involution
 Lax ligament - pregnancy
CAUSES
Increase in intra abdominal
pressure
1. Abdominal mass
2. Ascitis
3. Chronic cough
DEGREE
1.In first-degree prolapse- the
prolapsed wall extends to but not
through the cervix.
2.In second-degree prolapse- the
prolapsed wall protrudes
through the cervix but remains 1
within the vagina.
3.In third-degree prolapse- the
prolapsed fundus extends outside 2
the vagina.
4. In fourth degree or total
3
prolapse or procidentia- both the
vagina and uterus are prolapsed 4
SYMPTOMS
 She feels a sense of fullness in
the region of the bladder and
rectum.
 Dragging discomfort in the
lower abdomen
 Low backache
 Heavy menses and milk
vaginal discharge
SYMPTOMS
 Increase in the frequency of
urination burning sensation due to
infection.
 The woman may experience
difficulty in passing stools and
complete evacuation of bowels.
 The condition may also result in
difficulty in normal sexual
intercourse.
MANAGEMENT
 A vaginal pessary is an object inserted
into the vagina to hold the uterus in
place. It may be a temporary or
permanent form of treatment.
 Surgery should wait until symptoms
are worse than the risks of having
surgery. The surgical approach
depends on:
Degree of prolapse
Desire for future pregnancies
Often, a vaginal hysterectomy is used
to correct uterine prolapse.
MANAGEMENT
 During pregnancy
 If the cervix is outside the introits-place the
cervix in vagina & kept in position by ring
pessary until 18-20 weeks of pregnancy
 Prolapsed mass covered by gauze soaked with
glycerin & acriflavine
 If the uterus remain outside the introits in
later months- it is preferable to admit the
patient at 36 weeks
 Patient lie in bed at foot end raised
DURING LABOUR
 Patient should be in bed
 Intravaginal packing soaked with glycerin &
acriflavine
 Prophylactic antibiotics
 If the head is deeply engaged with cervix
remaining thin but undilated
UTERINE INVERSION
 Inversions is a condition
where the uterus inside
turns out partially or
completely through the
cervix.
CAUSES
 Excessive cord traction
 Credé (fundal) pressure
 Placenta accreta
 Fundal implantation of the placenta
 Trials of vaginal birth following
cesarean delivery
 Precipitate labor
 Faulty technique in manual removal
DEGREES
 First degree- there is dimpling of the fundus,which still
remains above the level of internal os.
 Second degree-the fundus passes through the cervix but lies
inside the vagina.
 Third degree-the endometrial with or without the attached
placenta is visible outside the vulva.
SYMPTOMS
 Sensation of something
coming down per vaginum
 Irregular vaginal bleeding
 Acute lower abdominal pain

SIGNS
 Inspection- protruding mass
 Abdominal examination-Cup
shaped depression is felt at
fundus.
 Bimanual examination-
protrusion of a large, dark red,
pear shaped mass through the
vagina either accompanying or
MANAGEMENT
Before the shock develops
 Replace the uterus-It is
important that the part of the
uterus that came out last (the part
closest to the cervix) goes in first
To apply counter support with
other hand placed on abdomen.
After replacement the hand
should remain inside the uterus
until the uterus become contracted
The placenta removal manually
only after the uterus become
contracted.
AFTER THE SHOCK DEVELOPS
 Initiate fluid resuscitation with 2

large-bore intravenous lines.
Promptly administer 1 or more
liters of an isotonic salt solution
such as lactated Ringer parentrally.
 To push the uterus inside if possible
and pack the vagina with antiseptic
roller gauze
Cont..
 Foot end of bed is raised
 Replacement of uterus by manually
or by hydrostatic method
 If 2 or more attempts at manual
replacement are unsuccessful,
surgery is indicated. An abdominal
approach for uterine replacement is
favored
BIBLIOGRAPHY:
1)Dutta D.C 'Textbook of obstetrics' 6th

edition published by new book agency
(P) limited pp -312-313,421-422.
2)Jacob annamma ‘a comprehensive

textbook of midwifery ‘1st edition
published by jitender p vij pp 539-55
3)www.Google.com
RECAPTULISATION
Fill in the blanks:-
 Normal position of uterus is____________
Ans. Anteverted &anteflexed

 In first degree of prolapse of uterus the prolapsed
wall extends upto_______
Ans. Extends upto cervix but not through the cervix.

 Procendentia is _______
Ans. When both the vagina and uterus are prolapsed

TRUE/FALSE
 Sense of fullness felt in prolapsed uterus or not
Ans. True
 Increase in frequency of urine is felt in prolapsed
uterus or not
Ans. True
 Retroversion & retro-flexion is a normal shape
of uterus
Ans. False
 Uterine inversion is caused by faulty technique
in removal of placenta
Ans.True

Displacement of Uterus

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DISPLACEMENT

it mean that the axis of the

 Acquired during L&D

5. Mid cyclic pain

2. Absent of the uterus

Avoid bearing down

Avoid breach extraction before full

 Prolapse of the uterus refers to the

Lack of exercise and bodily

Repeated deliveries and manual

 Irregular vaginal bleeding

 Acute lower abdominal pain

 Initiate fluid resuscitation with 2

1)Dutta D.C 'Textbook of obstetrics' 6th

2)Jacob annamma ‘a comprehensive

Ans. Anteverted &anteflexed

Ans. Extends upto cervix but not through the cervix.

Ans. When both the vagina and uterus are prolapsed

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