Uterine Inversion

I. Definition

Uterine inversion is a condition in which the inner surface of the fundus comes out through the cervix. In other words, the uterus “turned inside out.” The placenta appears at the introitus with a mass attached.





II. Causes/ Risk Factors
- Almost always a consequence of strong traction on an umbilical cord attached to placenta implanted on the fundus
- Abnormal implantation such as placenta accrete, increta and percreta
- Manual removal of the placenta
- Uterine atony
- Congenital or myometrial weakness
- Previous uterine inversion





III. Types
A. Complete
- the uterus extends beyond the level of the cervix with a dark, beef-looking mass inside the vagina or outside the introitus

B. Incomplete
- the uterus does not extend beyond the cervix, with a mass only palpable or visible at the cervix.





IV. Classification

A. Acute
- occur immediately after, or moments after, delivery; cervix is not yet constricted

B. Sub-acute
- occur immediately after, or moments after, delivery; cervix is constricted

C. Chronic
- inversion that occurred longer than 4 weeks postpartum




V. S/S

Uterine inversion often results in profuse bleeding which, without prompt treatment, leads to shock and even death. The severity of shock has been observed to be disproportionate to the blood loss due to underestimation of bleeding or possibly to neurogenic shock caused by immense pain. Furthermore, other complications aside from those mentioned include infection and endomyometritis, and injury to neighboring structures such as the intestines and bladder. The woman may be bradycardic because of increased vagal tone.