Uterine inversion is a severe obstetric complication in which the fundus of the uterus collapses downwards, passing through the uterine cavity and the cervix, essentially turning the uterus inside out.
Uterine inversion is a rare event, with a reported incidence varying from 1 in 2000 to 1 in 50,000 deliveries. The risk factors associated with uterine inversion include prolonged labour, rapid and forceful delivery, and fundal placental implantation.
The exact cause of uterine inversion is not entirely understood, but it is believed to be associated with excessive traction applied to the umbilical cord before placental separation. Other contributing factors may include relaxed or atonic uterus, short umbilical cord, or previous uterine inversion.
The primary symptom is a large post-partum haemorrhage.
Uterine atony, retained placental fragments, cervical and vaginal lacerations are some of the conditions that need to be differentiated from uterine inversion. These conditions also present with post-partum haemorrhage, but do not have the characteristic presentation of the fundus of the uterus dropping down through the uterine cavity and cervix.
The diagnosis of uterine inversion is primarily clinical, based on the characteristic presentation. However, ultrasound imaging can be useful in confirming the diagnosis and ruling out other causes of post-partum haemorrhage.
The management of uterine inversion focuses on maternal resuscitation and repositioning of the uterus. The primary methods include: