Uterine inversion

Uterine inversion is a potentially fatal childbirth complication with a maternal survival rate of about 85%. It occurs when the placenta fails to detach from the uterus as it exits, pulls on the inside surface, and turns the organ inside out. It is very rare.

Causes

The most common cause is the mismanagement of 3rd stage of labor, such as:

• Fundal pressure
• Excess cord traction during the 3rd stage of labor

Other natural causes can be:

• Uterine weakness, congenital or not
• Precipitate delivery
• Short umbilical cord

It is more common in multiple gestation than in singleton pregnancies.

The incidence is of 1/2000 pregnancies.

Types

• ONE: Complete. Visible outside the cervix.
• TWO: Incomplete. Visible only at the cervix.

Associations

• Placenta praevia
• Fundal Placental Implantation
• Use of Magnesium Sulfate
• Vigorous fundal pressure
• Repeated cord traction
• short umbilical cord

Presentation

Uterine inversion is often associated with significant Post-partum hemorrhage. Traditionally it was thought that it presented with haemodynamic shock "out of proportion" with blood loss, however blood loss has often been underestimated. The parasympathetic effect of traction on the uterine ligaments may cause bradycardia.