UTERINE INVERSION

Folding of uterus into the uterine cavity

• Iatrogenic
• Traction on umblical cord before the separation of placenta during
third stage of labour
• Very rare but serious condition
• Occurs in 1 out of 5000 pregnancies
• Need for prompt recognition and managment
 RISK FACTORS
Malpresentations
Prolonged second stage labour
Mismanagment of 3rd stage of labour
Placenta accreta
IV syntocinon prior to C section
Instrumental delivery
Hyperstimulated uterus
Full dilation sections
tumor or polyp
Degrees of uterine inversion
 First degree

• Fundus is inverted but does not extend

through cervix
 Second degree
•
• Inverted fundus extends through the cervix
but remains within the vagina
 Third Degree

• Inverted fundus extends outside vagina

 Fourth degree

vagina and uterus are inverted

completely and present outside the
introitus also called as UV Prolapse
Complete Incomplete
• Fundus passed through • Fundus hasn’t passed
cervix through cervix
• Second and third degree • First degree
• Acute
• During or immediately after third stage to 24 hours postpartum
• Subacute
• From 24 hours postpartum upto 4 weeks postpartum
• Chronic
• After 4 weeks postpartum
 CLINICAL FEATURES

• Severe lower abdominal pain

• Severe bleeding
• Symptoms of shock eg sudden collapse
• Abnormal fundus eg depression on fundus or nonpalpable
• Palpable mass in vagina or visible outside introitus
Managment
• Suspected from severe postpartum haemorrhage and shock
without explanation
• Requires prompt recognition and treatment
• First treat shock and stabilize patient
• Placenta is not detached until uterus is replaced and
contracted
• Replace uterus immediately via several techniques
1.Manual
2. Hydrostatic replacement
3. Surgical replacement
Requires tocolytics and anaesthesia
 Manual replacement of uterus

• First line treatment

• Utreus manually grabbed by hand and is pushed
back via vagina and cervix
O sullivian’s hydrostatic method

• 2 to 3 liters of warm saline is introduced via tubing into vagina while

hands are used to create seal around vulva
• Leads to vaginal vault and cervical ballooning
• Gradual correction of inversion
 Surgical method

Fundus is hooked up and resutured

Hysterectomy performed
 Prevention
• Controlled cord traction
• Wait for signs of pacental separation before
starting active management during 3rd stage of
labour
• No fundal pressure