Objectives

On successfully completing this topic, you will be able to:

• recognise and manage uterine inversion.

Introduction

Reported incidence ranges from 1/2000 to 1/6400. Although it has often been thought to be related to mismanagement of the third stage, uterine inversion was found even in an institution that did not use the Crede's manoeuvre, where they strongly discourage vigorous cord traction and where oxytocin was not given until after placental separation. Brar et al. found a fundal placenta in the majority of women. Other associated obstetric conditions include a short cord, a morbidly adherent placenta and uterine anomalies.

Inversion of the uterus can be puerperal and nonpuerperal. However, chronic nonpuer peral uterine inversions are rare. In a study by Mwinyoglee et al., only 77 cases were reported; 75 (97.4%) were tumour-produced and 20% of these tumours were malignant.

Puerperal uterine inversions can follow vaginal delivery or occur at CS. Usual causes are cord traction before the uterus has contracted, but especially when there is a short umbilical cord, fundal insertion of placenta or an adherent placenta. Prompt understanding and repositioning by manual replacement will prevent further complications.

Immediate, nonsurgical measures are successful in the vast majority of cases of uterine inversion. The pooled experience of Brar et al. and Watson demonstrated only three laparotomies requiring surgical reposition out of a total of 102 uterine inversions.