Uterine inversion occurs when the uterus turns inside out, most commonly during delivery from excessive cord traction or fundal pressure. It can range from the fundus inverting into the cervix to the entire uterus prolapsing outside the body. Prompt diagnosis and management is needed to prevent shock. The uterus must be manually or surgically replaced before detaching the placenta to avoid hemorrhage. Prevention involves controlled cord traction and avoiding fundal pressure until the placenta separates naturally.

2. UTERINE INVERSION

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

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
4th Degree
Prolapse of
inverted uterus
and vagina

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
ergometrine 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