Uterine inversion is a rare obstetric emergency in which the uterine corpus turns inside out and protrudes into the vagina or beyond the introitus, which can result in hemorrhage or shock, or even maternal death. Management is immediate reduction of the uterus to return it to its normal anatomic position.
The most common cause of uterine inversion is excessive traction applied to the umbilical cord in an attempt to deliver the placenta. The following conditions can contribute:
Excessive pressure on the fundus during delivery of the placenta
Uterine atony
Placenta accreta (abnormally adherent placenta)
Diagnosis of Uterine Inversion
Clinical evaluation
Diagnosis of uterine inversion is clinical. Patients may have postpartum hemorrhage and hypotension. On abdominal examination, the fundus may not be palpable or may be lower than expected. The inverted fundus is visible at or beyond the vaginal introitus.
Treatment of Uterine Inversion
Manual reduction of uterus to normal position
Intravenous fluids or blood product transfusion, if needed for hypovolemia or hemorrhage
Uterine inversion is an emergency, and clinicians should call for additional staff experienced with obstetric emergencies and anesthesiologists or operating room personnel, if needed. Intravenous fluids should be given if needed to support hemodynamic status. If postpartum hemorrhage occurs, a complete blood count and coagulation tests should be done, and transfusion of blood products given, if necessary.
Treatment is immediate manual reduction by pushing up on the internal aspect of fundus until the uterus is returned to its normal position. If the placenta is still attached, the uterus should be replaced before the placenta is removed.
If attempts to return the uterus are unsuccessful, a laparotomy may be necessary to facilitate both vaginal and abdominal manipulation to restore the uterus to its normal anatomic position.
