When there is a septic discharge from the vagina, the sound should be passed in the dorsal position and through a speculum.
REPOSITION OF A CHRONIC UTERINE INVERSION
Indications. Chronic inversion of the uterus, with severe hæmorrhage and bearing-down pain. The uterine fundus presents in the vagina and simulates a fibroid polypus in process of extrusion.
Operation. This is most likely to be successful if continuous pressure be brought to bear against the inverted fundus while an attempt is made simultaneously to dilate the contracted cervix.
Fig. 54. Chronic Uterine Inversion. Aveling’s repositor in place with elastic cords A, B, and C, in action.
The patient is placed under an anæsthetic in the dorsal position and the whole hand is passed gradually into the vagina. The tips of the fingers and thumb should be pressed into the circular space at which the flexion of the walls of the body on the cervix has occurred. With the palm of the hand upward pressure is made, counter-pressure being exerted by the other hand over the lower hypogastrium. Reduction usually begins by a slight dimpling of the inverted fundus.
A more scientific method of exerting continuous pressure is by the application of Aveling’s sigmoid repositor and elastic cords (Fig. 54). This instrument consists of a vulcanite cup into which is secured a steel S-shaped rod terminating below in a loop. The cup is made of various sizes and should always be smaller than the inverted fundus over which it fits.
After it has been applied, the instrument is carefully packed round with gauze to keep it in place. Two elastic bands in front and two behind are fastened by one end to the steel loop and by the other end to an abdominal belt. By this means constant and direct pressure is obtained on the fundus uteri in the direction of the pelvic axis.
Pain is usual and must be relieved by morphine. The cup usually elevates the fundus and corrects the inversion in about twenty-four hours, but as much as three days has been occupied in the process.