Uterine inversion occurs when the uterus turns inside out, most commonly during delivery from excessive cord traction or fundal pressure. It has an incidence of 1 in 2000 deliveries. Uterine inversion can be first, second, or third degree depending on how far the uterus prolapses. Symptoms include abdominal pain, postpartum hemorrhage, and shock. Treatment requires prompt recognition and replacement of the inverted uterus manually or with hydrostatic pressure before detaching the placenta, as well as treatment for shock. Prevention focuses on controlled cord traction and avoiding fundal pressure until after placental separation.

1. UTERINE INVERSION

2. GOALS
1. To learn how to diagnose uterine
inversion
2. Steps to manage uterine inversion

3. 1
2
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4. UTERINE INVERSION
Incidence : 1 in 2000 deliveries
Causes:
 Mismanagement of 3rd stage
 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

5. CLASSIFICATION
1st Degree
- Inverted fundus
up to cervix
2nd Degree
- Body of uterus
protrudes through
cervix into vagina
3rd Degree
- Prolapse of
inverted uterus
outside vulva

6. CLINICAL PRESENTATION
 Abdominal pain
 Post-partum haemorrhage
 Sudden collapse – degree of shock may
be inconsistent with the amount of
blood loss
 Absence of uterine fundus @
depression over fundus
 Fleshy mass at or outside the introitus
(dark red-blue bleeding mass)

7. MANAGEMENT
 Prompt recognition and treatment
 Should be suspected if profound shock without obvious
explanation
 Treat vasovagal shock (i.e. ABC, IV access, GXM)
 Placental should not be detached until the uterus is
replaced and contracted
 Replace uterus immediately- several techniques
 Manual or hydrostatic replacement
 Surgical replacement
 May require tocolytics, anaesthesia, or both

8. MANUAL REPLACEMENT OF UTERUS
 Replace by pressing first
on that part of the uterus
which inverted last
Once replaced, keep hand
inside uterus until
ergotmetrine or oxytocin
has produced a firm
contraction

9. O’SULLIVAN’S HYDROSTATIC METHOD
 Tube passed into the
posterior fornix
 Assistant close vulva
around operator’s wrist
 Warm saline run in until
pressure gradually
restores position of
uterus

10. Silicon Vacuum cup

11. SURGICAL REPLACEMENT OF UTERUS
 Constricting ring stretched
 Posterior part of ring divided
 Fundus hooked up and resutured

12. PREVENTION
 Controlled Cord Traction – avoid excessive
traction
 Wait - Signs of placental separation
 NO Fundal Pressure