Uterine inversion

Question 1

What is uterine inversion?

Answer 1

Obstetric emergency in which the uterine fundus collapses into the endometrial cavity, turning the uterus partially or completely inside out following vaginal birth

Question 2

What are the risk factors of uterine inversion?

Answer 2

Nulliparity
Cord traction (Brandt-Andrews maneuver) and excessive fundal pressure (Crede’s maneuver) during the third stage of labor
Difficult removal of the placenta
Use of uterine muscle relaxants (e.g., magnesium sulfate)
Fetal macrosomia
Uterine anomalies (e.g., relaxed lower uterine segment and cervix) or tumors
Placenta accreta

Question 3

What are the clinical features of uterine inversion?

Answer 3

Brisk postpartum hemorrhage
Round mass (inverted uterus) protruding from the cervix or vagina
Absent fundus (top of the uterus)

Question 4

How is uterine inversion diagnosed?

Answer 4

Clinical features

Ultrasound

Question 5

What is the treatment for uterine inversion?

Answer 5

Discontinue oxytocin
Administer crystalloids and blood products as needed
Reposition uterus manually, if impossible → administer uterine relaxant (e.g., nitroglycerine, terbutaline, or magnesium sulfate), if ineffective → surgical repair
After uterine repositioning: oxytocin to induce placental extraction and prevent reinversion

Question 6

What are the complications of uterine inversion?

Answer 6

Haemorrhagic shock + Maternal death