A Text-book of Diseases of Women

by Charles B. Penrose

Replacement of the uterus may be effected in one of two ways: by bimanual reposition while the woman is in the dorsal position; or by instrumental reposition while the woman is in the knee-chest position.

In bimanual reposition the uterus is manipulated between the vaginal finger or fingers and the abdominal hand until the organ is brought to its normal position of anteversion ([Fig. 92]). Sometimes this may be more easily accomplished by introducing one or two fingers into the rectum.

After bimanual reposition the pessary should be introduced in the vagina, and the upper bar of the instrument should be carried behind the cervix by manipulation with the vaginal finger.

Bimanual reposition is often difficult or impossible in fat women and in those with rigid abdominal walls.

Fig. 92.—Bimanual reposition of the retroflexed uterus.

Instrumental reposition in the knee-chest position, however, is applicable to all cases in which a pessary is indicated. As this method is the one that should in general be followed, it will be described in detail.

Fig. 93.—Uterine repositor.

The woman should be placed in the knee-chest position. The perineum should be retracted and the cervix exposed with a Sims speculum. It will be observed that the cervix is directed forward toward the symphysis pubis. The uterine repositor ([Fig. 93]) is then introduced, and pressure is made in the posterior vaginal fornix upon the displaced fundus. The fundus may be felt with the repositor in this position. Sometimes, by grasping the cervix with a tenaculum and drawing it downward, the repositor may be applied with better effect ([Fig. 94]). It will often be observed that under this pressure the fundus immediately drops forward, while the cervix is turned backward through an angle of 90° or perhaps 180°, so that the external os looks no longer toward the symphysis pubis, but toward the hollow of the sacrum. The direction of the cervix shows plainly when the uterus is in the normal position. Instead of the uterine repositor we may use a small firm ball of cotton held in long forceps.