Uterine inversion

Learning objectives

Uterine inversion is a rare complication when the uterine fundus collapses into the endometrial cavity, turning the uterus partially or completely inside out
A life-threatening obstetric emergency as it can lead to severe blood loss, shock, and even maternal death
In extremely rare cases (5% of uterine inversions), fibroids or tumors cause uterine inversion
Four degrees of uterine inversion:
- 1st degree (incomplete): the fundus is within the endometrial cavity
- 2nd degree (complete): the fundus protrudes through the cervical os
- 3rd degree (prolapsed): the fundus protrudes to or beyond the introitus
- 4th degree (total): both the uterus and vagina are inverted and protrude outside the body
Time of occurrence:
- Acute: within 24 hours of delivery
- Subacute: more than 24 hours but less than four weeks postpartum
- Chronic: ≥ 1 month postpartum
The incidence ranges from 1 in 3500 to 20,000 deliveries

Mismanagement of the third stage of labor such as:
- Fundal pressure
- Excess cord traction during the third stage of labor
Other natural causes can be:
- Uterine weakness
- Precipitate delivery
- Short umbilical cord
It is more common in multiple gestations than in singleton pregnancies

Clinical findings
Ultrasound examination shows an abnormal uterine fundal contour with a homogenous globular mass within the uterus