OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is uterine inversion. While this may seem a odd practice, it is useful to see multiple examples of how uterine inversion will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
QUESTION EXAMPLES
Question # 1
A 33 year old woman, G2 P1, has a very raid spontaneous vaginal delivery of a 10 lb baby boy at 39 weeks gestation. Her prenatal course was uncomplicated. her prior pregnancy was also delivered vaginally, and she does not have any remarkable past medical history. After about 15 minutes, the placenta does not deliver. Traction applied to the umbilical cord, and fundal massage administered by the medical team are not helpful. Eventually the umbilical cord avulses, and after a little while, the patient begins to develop severe abdominal pain, shortness of breath, and a large amount of vaginal bleeding is noticed. The patient’s blood pressure is now 75/40 mm Hg, and her pulse is 63/min. Physical exam reveals the presence of a smooth, round, and pale mass protruding from the vagina. The attending physician is no longer able to palpate the uterus on the abdominal exam. What has most likely occurred in this patient?
Explanation: firm pale mass in the vagina + unable to palpate the uterus = uterine inversion
Question # 2
A 30 year old woman, G3P2, delivers a 9 lb newborn at term following a 2 hour course of labor. The placenta is delivered 12 minutes later using gentle cord traction. After the placenta is delivered, a firm pale mass is noted in the lower vagina. There is also moderate vaginal bleeding noted. The patient suddenly develops shortness of breath. Her pulse is 65/min, blood pressure is 65/40 mm Hg. During abdominal examination the uterus can not be palpated. The administrate of intravenous saline does not improve her symptoms. What is the likely diagnosis?
Explanation: firm pale mass in the vagina + unable to palpate the uterus = uterine inversion
Question # 3
A 29 year old G2P2 is immediately status post a vaginal delivery. The placenta was delivered with moderate traction applied to the umbilical cord. She is bleeding briskly despite pitocin administration and her estimated blood loss is already more then 1000 ml. On exam you cannot feel her fundus and she has a large bulging mass in the vagina. What is the most likely diagnosis?
Explanation: unable to palpate fundus + bulging mass in the vagina = uterine inversion
Page Updated: 10.04.2016