Uterine inversion is a rare complication of vaginal delivery in which the uterus partially or completely turns inside out. Complete inversion is when the uterus is turned completely inside out, with the very top of the uterus protruding through the cervix. The entire uterus rarely prolapses out of the vagina.
The immediate problem with uterine inversion is postpartum hemorrhage. Bleeding can be massive and patients may go into shock. Though this condition can be fatal, it can be successfully treated with rapid recognition, intravenous fluids, and blood transfusion.
Though the exact cause of uterine inversion is not well understood, the following factors are associated with it:
- placenta accreta (when the placenta implants too deeply in the wall of the uterus);
- previous uterine inversion;
- fundal implantation of the placenta (when the placenta implants at the very top of the uterus);
- magnesium sulfate therapy during labor; and
- forceful pulling of the umbilical cord in attempts to deliver the placenta.
Careful and gentle management in the delivery of the placenta helps prevent uterine inversion. The umbilical cord should never be forcefully pulled. In the case of a retained placenta, vigorous manual removal of the placenta should be avoided.
