Uterine Inversion: Symptoms, Causes, Treatment

What are the symptoms of uterine inversion?

The symptoms of uterine inversion, a rare but serious childbirth complication where the uterus turns inside out and partially or completely protrudes into the vagina, include:

• Severe lower abdominal pain immediately after childbirth.
• Mass or tissue protruding from the vagina, often appearing as a red, fleshy mass.
• Heavy vaginal bleeding (postpartum hemorrhage), which can be life-threatening.
• Drop in blood pressure (hypotension) due to significant blood loss.
• Rapid heart rate (tachycardia) as the body compensates for blood loss.
• Dizziness, lightheadedness, or fainting due to blood loss and shock.
• Paleness and cold, clammy skin, signs of shock.
• Difficulty in delivering the placenta, or the placenta remains attached even as the uterus inverts.

Uterine inversion is a medical emergency that requires prompt recognition and treatment to prevent severe complications.

What are the causes of uterine inversion?

The causes of uterine inversion, where the uterus turns inside out during or after childbirth, include:

• Excessive pulling on the umbilical cord during the third stage of labor (delivery of the placenta).
• Abnormally adherent placenta (placenta accreta), where the placenta is too strongly attached to the uterine wall.
• Weak uterine muscles or atony, making the uterus more prone to inversion.
• Rapid or forceful delivery of the baby or placenta.
• Use of excessive manual pressure on the uterus during delivery (e.g., fundal pressure).
• Congenital or structural uterine abnormalities that predispose the uterus to inversion.
• Previous history of uterine inversion, which increases the risk in subsequent deliveries.

While rare, uterine inversion is a serious complication that can lead to severe bleeding and shock, requiring immediate medical intervention.

What is the treatment for uterine inversion?

Treatment for uterine inversion is a medical emergency aimed at quickly correcting the inversion and managing complications such as hemorrhage. The treatment involves:

• Manual Repositioning: The first step is usually attempting to manually reposition the uterus back into its normal position. This is done by a healthcare provider using specific techniques to push the uterus back into place through the vagina.
• Uterine Relaxation Medications: Medications like nitroglycerin, terbutaline, or magnesium sulfate may be used to relax the uterine muscles, making it easier to reposition the uterus.
• Surgical Repositioning: If manual repositioning is unsuccessful, surgery may be necessary. Procedures include laparotomy (opening the abdomen) to manually reposition the uterus or, in some cases, a cesarean section.
• Treating Hemorrhage: Severe blood loss is common in uterine inversion. Immediate measures, including intravenous fluids, blood transfusions, and medications (like oxytocin) to contract the uterus and control bleeding, are often required.
• Antibiotics: Prophylactic antibiotics may be administered to prevent infection after the procedure.
• Hysterectomy: In extreme cases, if bleeding cannot be controlled or the uterus cannot be repositioned, a hysterectomy (removal of the uterus) may be necessary.

Quick and effective treatment is crucial for saving the life of the patient and preventing complications.