Treatment should begin as soon as uterine inversion is recognized. The doctor pushes the top of the uterus back into the pelvis through the dilated cervix. If the placenta hasn't yet separated, it is not removed until the uterus is repositioned. General anesthesia--such as halothane (Fluothane) gas--or other medications (such as magnesium sulfate, nitroglycerin, or terbutaline) may be required. Once the uterus is replaced, oxytocin (Pitocin) and methylergonovine (Methergine) are given to help the uterus contract and prevent it from inverting again. A doctor or nurse will massage the uterus until it contracts fully and bleeding stops. Intravenous fluids are given and a blood transfusion if necessary. Antibiotics are given to help prevent infections in the uterus. If the placenta is still undelivered, it can then be removed manually (the doctor reaches into the uterus to dislodge the placenta).
If efforts to manually reposition the uterus are unsuccessful, an operation may be necessary. The patient is given anesthesia and the abdomen is surgically opened. The uterus is then repositioned and the abdomen is closed. If a tight band of contracted tissue in the uterus is preventing it from being repositioned, an incision may be made along the back portion of the uterus. The uterus is then replaced and the incision in the uterus is repaired; in this case, any future pregnancies should be delivered by cesarean section.
If the placenta cannot be separated from the uterus, a hysterectomy (removal of the uterus) may be necessary.
