Treatment

IV fluids, Normal saline, alternating with Ringer’s lactate as per extent of blood loss.

Blood transfusion if indicated.

Manual Uterine replacement (Johnson’s Maneuvers).

To restore the proper location of the uterus, a hand is placed inside the vagina pushing the fundus along the long axis of the vagina toward the umbilicus. This procedure might require general anaesthesia.

Hydrostatic Reduction (O’Sullivan technique)

Uterine rupture must be excluded before proceeding with this procedure. Warm Saline is infused using the largest giving set available into
the vagina with 2 to 3 litres whilst the introitus is manually sealed.

Surgical uterine replacement.

Under spinal or general anaesthesia, surgical replacement is done after failure of a manual technique.

Uterotonic medications (after uterus replacement) to prevent PPH.

Placental removal (after uterus replacement) if the placental is still attached to the uterus.

Hysterectomy in case of failure of the above treatment options.