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Uterine inversion — reduction

Johnson’s manoeuvre and O’Sullivan hydrostatic method.

Source: Worcestershire NHS · RANZCOG
Stop oxytocin. Leave the placenta attached until reduced. Call for help and resuscitate — shock out of proportion to blood loss.

Johnson’s manoeuvre

  1. Palm on the fundus, push it up through the cervix toward the umbilicus.
  2. “Last out, first in” — replace the part nearest the cervix first.
  3. If a constriction ring forms: terbutaline 250 micrograms SC or GTN spray.

O’Sullivan hydrostatic

  1. Exclude uterine rupture.
  2. Run warm saline (~3 L) into the vagina from 1–2 m height.
  3. Seal the introitus with hands or a silicone ventouse cup.
After reduction: oxytocin infusion, bimanual compression, antibiotics. Surgical: Huntington or Haultain procedure.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.