Fig. 141.—Emmet’s method of retaining partially reduced inversion.
Reduction of chronic inversion by manual methods is a long and exhausting process, requiring sometimes three or four hours for its accomplishment. It is advisable to have several assistants for mutual relief. It may be necessary to desist, and to repeat the operation when the condition of the patient permits it. In case the reduction can be but partially accomplished, or when, from any cause, the attempt at reduction has to be temporarily abandoned, the result of the work done may be preserved by a method of Emmet’s of temporarily closing the cervix by suture ([Fig. 141]). This procedure not only prevents the complete inversion from returning, but the traction produced by stretching the cervix over the fundus itself favors reduction.
Reduction by Continuous Elastic Pressure.—This method is employed after the manual method has failed, or it may be used primarily. As has been said, the gradual pressure of a colpeurynter has in several instances accomplished reduction.
The most efficient instrument for maintaining continuous pressure consists of a wooden cup set on a stem that extends out of the vagina. Pressure is made by firm elastic bands attached to the stem; these bands pass, two in front and two behind, to a broad abdominal bandage. The elastic pressure is maintained for from one to three weeks.
The parts must be carefully watched for sloughing. The rim of the cup of the repositor should be covered with lint saturated with carbolized oil. The instrument should be removed and reapplied every day.
The direction of pressure may be regulated by the tension of the elastic bands.
Splitting the posterior lip of the cervix is sometimes a useful procedure in cases that have resisted other treatment. The cervix is split in the median line posteriorly; the body and fundus are replaced by taxis, and the incision is then closed by suture.
If inversion accompany a uterine polyp, the tumor should be removed; and if the inversion is not spontaneously corrected, it must be reduced.
If, after careful trial of conservative methods, reduction of an inverted uterus is found to be impossible, the physician may be compelled to amputate the inverted portion or perform hysterectomy.