A uterine inversion is a rare complication of vaginal delivery where the uterus partially or completely turns inside out.
Although a uterine inversion does not occur often, when it does there is a high risk of death due to severe bleeding and shock. However, it can be treated successfully with quick diagnosis, intravenous fluids, and a blood transfusion.
Causes and risk factors
The exact cause of uterine inversion is not well understood. However, the following risk factors are associated with it:
- labor lasting longer than 24 hours
- a short umbilical cord
- prior deliveries
- use of muscle relaxants during labor
- abnormal or weak uterus
- previous uterine inversion
- placenta accreta, in which the placenta is too deeply embedded in the uterine wall
- fundal implantation of the placenta, in which the placenta implants at the very top of the uterus
Also, pulling too hard on the umbilical cord to remove the placenta may cause uterine inversion. The umbilical cord should never be forcefully pulled. The placenta should be carefully and gently managed.
In the case of a placenta that has not been delivered within 30 minutes after childbirth, forceful manual removal should be avoided. Otherwise, there may be hemorrhaging and an infection could develop.
A doctor can usually diagnose a uterine inversion easily. Possible symptoms include:
- the uterus is protruding from the vagina
- the uterus doesn’t feel like it’s in the right place
- massive blood loss or a rapid decrease in blood pressure
The mother may also experience some of the following symptoms of shock:
- shortness of breath
Grades of inversion
Uterine inversion is defined by the severity of the inversion. These categories include:
- incomplete inversion, in which the top of the uterus has collapsed, but none of the uterus has come through the cervix
- complete inversion, in which the uterus is inside out and comes out the cervix
- prolapsed inversion, in which the top of the uterus is coming out of the vagina
- total inversion, in which both the uterus and the vagina are inside out
Treatment should begin as soon as uterine inversion is recognized. The doctor may be able to push the top of the uterus back into the pelvis through the dilated cervix. If the placenta hasn't separated the uterus is usually repositioned first.
Once the uterus is repositioned, oxytocin (Pitocin) and methylergonovine (Methergine) are given to help the uterus contract and prevent it from inverting again. Either a doctor or nurse will massage the uterus until it contracts fully and bleeding stops.
The mother will be given intravenous fluids and a blood transfusion if necessary. She will also be given antibiotics to prevent infection. If the placenta is still undelivered, the doctor may have to remove it manually.
There is also a newer technique to correct a uterine inversion using a balloon device and water pressure. A balloon is placed inside the uterine cavity and filled with a saline solution to push the uterus back into position.
The procedure is simple and has been successful in repositioning the uterus. It is also effective at stopping blood loss and preventing the uterus from inverting again.
If the doctor is unable to manually reposition the uterus an operation may be necessary. The mother will be given anesthesia and her abdomen will be surgically opened. The uterus will then be repositioned and the abdomen closed.
If a tight band of contracted tissue in the uterus prevents it from being repositioned, an incision may be made along the back portion of the uterus. The uterus can then be replaced and the incision repaired.
If surgery is needed, future pregnancies will require a cesarean delivery. If the placenta can’t be separated from the uterus, a hysterectomy may be necessary.
A uterine inversion is a rare and serious condition. It can lead to massive bleeding, shock, and can even be fatal. There are factors that put some women at a higher risk, but the condition can happen to anyone. In instances where the uterus can’t be put back into position, surgery may be required.
The condition is generally easy to diagnose and quick action and treatment are essential to correcting this condition and ensuring the health and well-being of the mother. If treated quickly, the mother can recover fully without long-term damage to her uterus.