Uterine inversion is a rare complication of birth, where the fundus of the uterus drops down through the uterine cavity and cervix, turning the uterus inside out. It is a very rare occurrence, and you are unlikely to see one in your career unless you become a midwife or obstetrician. It is a life-threatening obstetric emergency.
Incomplete uterine inversion (partial inversion) is where the fundus descends inside the uterus or vagina, but not as far as the introitus (opening of the vagina). Complete uterine inversion involves the uterus descending through the vagina to the introitus.
Uterine inversion may be there result of pulling too hard on the umbilical cord during active management of the third stage of labour.
Presentation
Uterine inversion typically presents with a large postpartum haemorrhage. There may be maternal shock or collapse.
An incomplete uterine inversion may be felt with manual vaginal examination. With a complete uterine inversion, the uterus may be seen at the introitus of the vagina.
Management
There are three options for treating uterine inversion:
- Johnson manoeuvre
- Hydrostatic methods
- Surgery
Initial management of an inverted uterus is with the Johnson manoeuvre, which involves using a hand to push the fundus back up into the abdomen and the correct position. The whole hand and most of the forearm will be inserted into the vagina to return the fundus to the correct position. It is held in place for several minutes, and medications are used to create a uterine contraction (i.e. oxytocin). The ligaments and uterus need to generate enough tension to remain in place.
Where the Johnson manoeuvre fails, hydrostatic methods can be used. This involves filling the vagina with fluid to “inflate” the uterus back to the normal position. It requires a tight seal at the entrance of the vagina, which can be challenging to achieve.
Where both non-surgical methods fail, surgery is required. A laparotomy is performed (opening the abdomen) and the uterus is returned to the normal position.
Other measures to stabilise the mother and treat the consequences may be required. For example, they may require resuscitation, treatment of postpartum haemorrhage and blood transfusion.
Last updated September 2020