Obstetric emergencies: uterine inversion: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Obstetric emergencies: uterine inversion

Sample item

A woman develops sudden shock out of proportion to blood loss after cord traction in the third stage, with a mass at the introitus and absent fundus on abdominal palpation. What is the first step in management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Immediate manual replacement of the uterus (Johnson manoeuvre) and stop uterotonics

Acute uterine inversion is corrected by pushing the fundus back through the cervix along the axis of the vagina (Johnson's manoeuvre) immediately, with fluid resuscitation. Uterotonics are withheld until replacement. Hydrostatic reduction (O'Sullivan) or tocolytics help if difficult.

Option by option

  • A. Give more oxytocin

    Uterotonics before replacement make a cervical ring tighter.

  • B. Perform hysterectomy

    Hysterectomy is only for failed replacement.

  • C. Observation

    Delay allows the ring to constrict.

  • D. Immediate manual replacement of the uterus (Johnson manoeuvre) and stop uterotonics (correct)

    Correct. Prompt replacement relieves neurogenic shock.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Immediate manual replacement of the uterus (Johnson manoeuvre) and stop uterotonics. Acute uterine inversion is corrected by pushing the fundus back through the cervix along the axis of the vagina (Johnson's manoeuvre) immediately, with fluid resuscitation.

Why is "Give more oxytocin" not the answer?

Uterotonics before replacement make a cervical ring tighter.

Why is "Perform hysterectomy" not the answer?

Hysterectomy is only for failed replacement.

Why is "Observation" not the answer?

Delay allows the ring to constrict.

What concept does this question test?

It tests Obstetric emergencies: uterine inversion in OBG. Uterotonics are withheld until replacement. Hydrostatic reduction (O'Sullivan) or tocolytics help if difficult.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Obstetric emergencies: uterine inversion?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.