Uterine inversion is a potentially life-threatening complication of childbirth.

Normally, the placenta

detaches from the uterus and exits the vagina around half an hour after the baby is delivered. Uterine
inversion means the placenta remains attached, and its exit pulls the uterus inside-out.

Description:

 Puerperal Inversion of the uterus is one of the classic hemorrhagic disasters encountered in
Obstetrics. Unless promptly recognized and managed appropriately, associated bleeding often is
massive.
 Uterine inversion occurs rarely
 Uterine inversion is more common in grand multiparous women

Risk Factors

1. Fundal placental implantation

2. Uterine Atony

3. Cord traction applied before placental separation

4. Abnormally adhered placentation such as with the accrete syndrome

Some of the signs of uterine inversion:

 The uterus protrudes from the vagina

 The fundus doesn’t seem to be in its proper position when the doctor palpates the mother’s
abdomen
 The mother experiences greater than normal blood loss
 The mother’s blood pressure drops

Grades of inversion

1. Incomplete inversion – the top of the uterus has collapsed, but the uterus hasn’t come through the
cervix.

2. Complete inversion – the uterus is inside-out and coming through the cervix

3. Prolapsed inversion – the fundus of the uterus is coming out of the vagina

4. Total inversion – both the uterus and vagina protrude inside-out

Degrees:

1. First degree: the uterus is partially turned out

2. Second degree: The fundus has passed through the cervix but not outside the vagina

3. Third degree: the fundus is prolapsed outside the vagina

4. Fourth degree: The uterus, cervix and vagina are completely turned inside out and are visible
According to Timing of Event

 Acute: It occurs within 24 hrs. of delivery

 Sub-acute: It presents between 24 hrs. & 4 wks. of delivery
 Chronic: It presents beyond 4 wks. of delivery or in non-pregnant stage

Causes

 Excessive cord traction (esp. with an unseparated placenta)

 Excessive fundal pressure (esp. when uterus is poorly contracted Atonic)
 Placenta accreta
 Congenital predisposition
 Fundal implantation of placenta
o Either spontaneous or latrogenic causes.

Maneuvers: to be avoided

 Excessive traction on the umbilical cord

 Excessive fundal pressure
 Excessive intra-abdominal pressure
 Excessively vigorous manual removal of placenta

Prevention

 Do not employ any method to expel the placenta when the uterus is relaxed
 Patient should not be instructed to change her position
 Pulling the cord simultaneously with fundal pressure should be avoided
 Manual removal of placenta should be done in proper manner

Clinical Presentation

 Abdominal Pain
 Post-partum hemorrhage
 Sudden collapse – degree of shock may be inconsistent with the amount of blood loss
 Absence of uterine fundus at depression over fundus
 Fleshy mass at or outside the introitus (dark red-blue bleeding mass)