The nurse is assisting a patient who just delivered a healthy baby boy weighing 3,400 grams. Upon cord traction of placenta, there is a sudden gush of a large amount of blood. The fundus is no longer palpable in the abdomen. Which of the following nursing interventions are most appropriate?

Assess vital signs
Do not attempt to remove the placenta
Notify the physician
Open established IV line for fluid replacement


•Uterine inversion is a medical emergency in which the inner uterine lining collapses into the vagina. Heavy vaginal bleeding will be seen, and the fundus is unable to be palpated in the abdomen. If not corrected immediately, cervical entrapment of the uterus may occur. 

•Risk factors include straining after the delivery, too-vigorous kneading of the fundus, or pulling on the cord before the placenta has separated.

•The physicianl should be notified immediately and IV fluids started to begin fluid replacement for blood loss.

•Administering oxytocic drugs only compound the inversion; uterotonic drugs should be discontinued to allow uterine relaxation for replacement.

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