Haultain's procedure

Published Date: 19th July 2016

Publication Authors: Amma JS, Morgan PR, Dhannapuneni JS

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Introduction 

Acute uterine inversion is rare but life threatening emergency in the third stage of labour. Prompt recognition and immediate management is the key to saving the patient's life. Traditional management options involve immediate manual replacement with or without hydrostatic pressure. When unsuccessful, surgical correction using Huntington and Haultain's procedures are used. Recently more conservative surgical techniques have been reported. We report a case managed successfully using modified Haultain's technique.

Case 

A 25-year-old para1 + 0 delivered a healthy male infant spontaneously after uncomplicated labour. She received 10 IU of syntocinon with delivery of anterior shoulder. After three unsuccessful attempts at delivering the placenta by a midwife, she started bleeding heavily and medical assistance was summoned. On arrival, the placenta with membranes filled blood was found at the vulva. The loosely attached placental membranes came off easily revealing complete uterine inversion. Immediate attempt at digital replacement of uterus was unsuccessful. She was transferred to theatre swiftly. Under general anaesthesia further attempt at manual replacement followed by hydrostatic pressure method were tried but unsuccessfully. Laparotomy was performed and 3 cm partial thickness vertical incision was made in the posterior uterine wall over the constriction ring and gentle upward traction exerted with Littlewood forceps on either side of incised edges. The incision was extended downwards as the fundus was advancing and two further Littlewoods applied below previous application in a stepwise manner until the uterus was returned to normal anatomical position.

Discussion 

Surgical correction of uterine inversion is required in minority of cases of uterine inversion. While Huntington's procedure involves application of traction on round ligaments, Haultain's procedure involves hysterotomy (full thickness incision) over the constriction ring to facilitate uterine replacement. In this case, a partial vertical incision was made in the posterior uterine wall as opposed to full thickness. This has advantages of not entering the uterine cavity thereby reducing risk of uterine rupture in future pregnancies; reducing the risk of infection and reducing surgical time with associated operative blood loss.

Dhannapuneni JS; Amma JS; Morgan PR. (2015).  Acute postpartum uterine inversion treated by modified Haultain's procedure . BJOG: An International Journal of Obstetrics and Gynaecology. 122 (Suppl S1), 166-167

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