A Text-book of Diseases of Women

by Charles B. Penrose

If the inversion be partial, the fundus lying still above the internal os, the difficulty of diagnosis becomes much greater. Examination under anesthesia may be necessary, when the cup-shaped depression on the top of the uterus may be detected, and dilatation of the cervix will enable the examiner to palpate the intra-uterine tumor.

The differential diagnosis between inversion and uterine polyp is made by determining, in the latter condition, that the body of the uterus lies in its normal relationship to the cervix, and that the upper surface is not cupped.

The sound usually passes to unequal distances around the neck of a fibroid polyp, unless it be situated symmetrically in the centre of the fundus. The depth of the uterus in the case of uterine polyp is usually greater than two and a half inches, as a result of the hypertrophy that accompanies polypi.

It is said that if the sound passes to a less depth than two and a half inches in the case of uterine polyp, accompanying partial inversion of the uterus should be suspected.

Treatment.—As I have already said, an inverted uterus should be reduced immediately after the accident occurs. If this is not done, the difficulties of reduction become very great. Until about fifty years ago, reduction in chronic cases was considered to be impossible. A considerable variety of methods of reduction have been recommended. Some operators advocate reduction by the hands alone; others advise the assistance of instruments; and others, again, the employment of continuous elastic pressure.

The woman should be kept in bed for a few days before the operation. Saline laxatives should be administered. The parts should be prepared by vaginal injections of hot water in large quantity, administered three times a day. A large Barnes bag or colpeurynter filled with air or water should be placed in the vagina for two or three days before the operation, in order to distend the genital tract sufficiently to admit the hand. In some cases the pressure of such a bag, applied for from one to eleven days, has itself effected reduction. At the time of operation an anesthetic should be administered and the woman should be placed in the lithotomy position. The bladder should be emptied.

Fig. 140.—White’s repositor for inversion of the uterus.

The hand should be greased before introduction into the vagina. Emmet describes the method of reduction as follows: “My hand was passed into the vagina, and, with the fingers and thumb encircling the portion of the body close to the seat of inversion, the fundus was allowed to rest in the palm of the hand. This portion of the body was firmly grasped, pushed upward, and the fingers were then immediately separated to their utmost; at the same time the other hand was employed over the abdomen in the attempt to roll out the parts forming the ring, by sliding the abdominal parietes over its edge. This manœuver was repeated and continued. At length, as the diameter of the uterine cervix and os was increased by lateral dilatation with the outspread fingers, the long diameter of the body of the uterus became shortened, and the degree of inversion proportionally lessened. After the body had advanced well within the cervix, steady upward pressure upon the fundus was applied by the tips of all the fingers brought together.”

The reduction may be aided by the use of White’s repositor ([Fig. 140]). This instrument consists of an india-rubber cup set on a curved iron staff which has at its other end a stout spiral spring. The cup is placed against the inverted fundus, and the spring against the body of the operator, who is thus enabled to maintain continuous pressure during the manipulations of his fingers.