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While 50% of cases of inversion of the uterus have no identifiable risk factors , mismanagement of the third stage (applying traction on the umbilical cord before contraction of the uterus and applying fundal pressure) is considered as the prime cause .Other recognised predisposing factors include uterine atony, fundal implantation of a morbidly adherent placenta, manual removal of the placenta, precipitate labour, a short umbilical cord, placenta praevia and connective tissue disorders (Marfan syndrome and Ehlers–Danlos syndrome) . It has also been reported to follow sudden increases in intra-abdominal pressure such as coughing or, sneezing before contraction of uterine muscles, delivery of a baby with cord around the neck, giving birth in sitting or erect position, precipitated labour  and very rarely during caesarean section . Even though individual risk factors do commonly occur, rarity of the condition indicates that these factors must act in unison to culminate in an inversion of the uterus.
This chapter describes the types, key implications and management strategies of massive obstetric haemorrhage. Antepartum haemorrhage due to placental abruption and intrapartum haemorrhage due to uterine rupture are associated with increased perinatal mortality. Visible blood loss greater than 2 litres, ongoing bleeding are some key pointers of massive obstetric haemorrhage. Immediate management involves active resuscitation to ensure a patient airway, breathing and maintaining circulation with intravenous fluids, blood and blood products as well as correction of coagulopathy. In women who are not acutely compromised or bleeding severely, interventional radiology can be considered. If the bleeding is predominantly from the lower segment, a total abdominal hysterectomy is warranted. Women with massive obstetric haemorrhage often need multi-organ support. Hence, transfer to an intensive care unit or high dependency unit should be considered for monitoring. Thromboprophylaxis should be considered once the coagulation parameters return to normal.