Overview
Uterine Inversion is a rare but life-threatening obstetric emergency in which the uterus turns inside out, usually occurring during or immediately after childbirth. This condition can result in massive hemorrhage, shock, and rapid deterioration if not immediately recognized and managed. Prompt medical intervention is essential to stabilize the patient and restore the uterus to its normal position.
What is Uterine Inversion
Uterine Inversion is a condition in which the uterus collapses into or outside of the vaginal canal after delivery, turning itself inside out. It most commonly occurs during the third stage of labor, especially if the placenta is pulled forcefully or the uterus fails to contract properly. Depending on severity, the uterus may be partially or completely prolapsed outside the body. Uterine inversion is a true obstetric emergency and requires immediate treatment to prevent maternal death.
Symptoms
Symptoms of uterine inversion typically appear suddenly and include:
- Severe vaginal bleeding (postpartum hemorrhage)
- Shock (low blood pressure, rapid heartbeat, pale or clammy skin)
- Severe lower abdominal or pelvic pain
- Visible uterus protruding from the vagina (in complete inversion)
- Nausea, dizziness, or fainting
- Inability to feel the uterus in its expected position during abdominal exam
Causes
Uterine inversion usually occurs as a complication of childbirth. Common causes include:
- Excessive traction on the umbilical cord during placental delivery
- Fundal pressure applied before placental separation
- Abnormally adherent placenta (placenta accreta)
- Uterine atony (failure of the uterus to contract properly)
- Short umbilical cord
- Rapid or difficult labor
- Use of uterine relaxants immediately after delivery
Risk Factors
- Multiparity (having had multiple births)
- Prolonged or rapid labor
- Uterine anomalies or weakness
- History of uterine inversion
- Manual removal of the placenta
- Placenta previa or placenta accreta
- Inappropriate fundal pressure during delivery
Complications
Uterine inversion can rapidly lead to life-threatening conditions if not treated urgently:
- Massive postpartum hemorrhage
- Hypovolemic shock
- Disseminated intravascular coagulation (DIC)
- Infection or sepsis
- Uterine necrosis (if blood supply is compromised)
- Need for emergency hysterectomy
- Maternal death in extreme cases
Prevention
Although not all cases can be prevented, appropriate obstetric management reduces the risk:
- Avoid excessive pulling on the umbilical cord before placental separation
- Do not apply fundal pressure improperly during labor
- Active management of the third stage of labor under skilled supervision
- Immediate recognition and management of uterine atony
- Training for birth attendants on safe delivery techniques
Treatment Options in Korea
South Korea offers advanced emergency obstetric care and highly skilled labor teams capable of managing uterine inversion with precision and speed:
- Initial stabilization:
- IV fluid resuscitation and blood transfusions for hemorrhagic shock
- Oxygen therapy and close vital sign monitoring
- Uterine repositioning (manual or surgical):
- Johnson maneuver – manual repositioning through the vagina
- Hydrostatic methods if manual repositioning fails
- Surgical correction (e.g., Huntington or Haultain procedure) if manual methods are unsuccessful
- General anesthesia or tocolytic medications may be used to relax the uterus during the procedure
- Post-reduction care:
- Uterotonic drugs (e.g., oxytocin) to maintain uterine tone
- Antibiotics to prevent infection
- Monitoring for recurrent bleeding or uterine rupture
- Psychological support and follow-up counseling
Korean maternity centers are equipped with emergency delivery suites, blood banks, surgical backup, and round-the-clock obstetric teams, ensuring that uterine inversion is rapidly addressed with excellent survival and recovery rates.
