Uterine Inversion

What is uterine inversion?

Uterine inversion (inverted uterus) is a rare emergency complication during childbirth where your uterus turns partially or completely inside out. With healthy deliveries, your baby exits your uterus (womb) and travels through your vaginal canal to be born. Shortly after, you’ll deliver the placenta, an organ that allows you to share nutrients with your baby during pregnancy. The placenta is called “afterbirth” once it leaves your body. Your uterus maintains its shape throughout delivery.

With uterine inversion, the top part of your uterus collapses inside the uterine cavity. It may even turn inside-out and extend outside your vagina. When this happens, severe blood loss, shock and death can follow.

A prepared care team that acts quickly can prevent these outcomes.

What are the degrees of uterine inversion?

There are four classifications of uterine inversion, depending on how inside out your uterus is and the extent that it projects onto other organs:

• 1st degree (incomplete): The top of your uterus has collapsed inside your uterine cavity.
• 2nd degree (complete): The top part of your uterus folds into the opening of your uterus (cervix), like a sock that is turned inside out.
• 3rd degree (prolapsed): The top part of your uterus enters the deepest part of your vaginal canal.
• 4th degree (total): Both your uterus and your vagina protrude outside your body.

The majority of people with uterine inversion fall into the 2nd or 3rd-degree categories.

How common is uterine inversion?

Uterine inversion is rare. It happens in anywhere from 1 in 3,500 to 1 in 20,000 deliveries. Most often, it occurs within the first 24 hours of delivery (acute uterine inversion). Less often, you may be diagnosed with uterine inversion within one month after having your baby (subacute uterine inversion) or after a month (chronic uterine inversion).

In extremely rare cases (only 5% of uterine inversions), the uterus doesn’t invert because of childbirth. Instead, structural irregularities like fibroids or tumors cause the uterus to invert.

What causes uterine inversion?

Not enough evidence exists to know for sure what causes an inverted uterus.

A popular theory is that your uterus may invert if your provider tugs on the umbilical cord too hard when trying to deliver the placenta. This isn’t an error on your provider’s part. Instead, it’s one of many complications that can occur during delivery.

Your provider may pull on the umbilical cord — the organ that connects your baby to the placenta — while placing gentle pressure on your abdomen to coax the placenta out. This is a delivery method called the Crede maneuver. This process is more likely to cause your uterus to invert if:

• Your placenta has implanted on the top of your uterus (fundal placental implantation). The placenta may attach to your uterine wall at the top, side, front or back during pregnancy. Most often, it connects at the top.
• Your uterus doesn’t contract after delivery (uterine atony). Usually, your uterus contracts after your baby is born. The squeezing helps deliver the placenta and reduces the size of your blood vessels so that they don’t bleed as easily.

It’s hard to prove this theory, though, because uterine inversion has taken place outside these conditions. Also, delivery methods like the Crede maneuver are common and rarely lead to uterine inversion.

What are the risk factors for uterine inversion?

The following risk factors are present in about half of uterine inversion cases:

• Short umbilical cord.
• Rapid or prolonged labor and delivery.
• Use of medicines that relax your uterus.
• First birth (not the same as your first pregnancy).
• A fetus that is heavier than average (fetal macrosomia).
• Retained placenta (the placenta isn’t delivered within 30 minutes of your baby being born).
• Severe preeclampsia (a pregnancy-related condition that may result in high blood pressure).
• Placenta accreta spectrum (the placenta grows so deeply into your uterine wall that it doesn’t separate during childbirth).

What are the signs and symptoms of uterine inversion?

Uterine inversion can cause severe blood loss and shock. Symptoms will vary, depending on how extreme the inversion is:

• Vaginal bleeding that may be mild or severe.
• Pain in your lower belly and a feeling of downward pressure.
• A smooth, round mass bulging from your vagina.
• Dropping blood pressure.

Symptoms of shock include:

• Feeling dizzy, light-headed, weak, confused, tired or drowsy.
• Rapid heartbeat and shallow breathing.
• Cold and clammy skin.
• Muscle cramps.
• Thirst.

How is uterine inversion diagnosed?

Your provider will be able to diagnose complete inversions just by looking. A visible uterus and heavy bleeding are telltale signs of an inverted uterus. Your provider may feel your abdomen to see if your uterus has shifted out of place.

Diagnosis has to happen quickly so that life-saving treatment can begin immediately.

How is uterine inversion treated?

Successful treatment depends on your provider’s ability to act quickly to keep your vitals stable while the top of your uterus is placed into its original position. The care you receive depends on the degree of inversion. It may involve:

• Added care team members. Additional staff may be needed to administer anesthesia to keep you pain-free, check your blood levels, deliver blood products as needed, and assist your provider.
• Manual reinsertion of your uterus. Your provider may try to gently push the top of your uterus back into place through your vaginal canal and cervix. You may receive medications that relax your uterus so that it’s easier to maneuver. If possible, your provider will leave the placenta attached to your uterus during reinsertion if it hasn’t separated already. Removing the placenta while your uterus is outside your body increases your risk of severe blood loss.
• Surgery (laparotomy). If your uterus can’t be inserted through your cervix or if you’re losing too much blood, your provider may perform a laparotomy. Your provider will make an incision into your abdomen to access your pelvic cavity and reposition your uterus.
• Stabilizing your uterus. Once your uterus is in place, you may be given drugs to help your uterus contract again. The squeezing reduces the risk of bleeding and helps keep your uterus in place.

Lifesaving procedures are performed in an operating room. Once the bleeding has stopped, you may be moved to the ICU so that blood products can be administered. You’ll be given blood transfusions as needed.

How can I prevent uterine inversion?

Uterine inversion can’t be prevented, but it can be effectively treated if your care team acts quickly.

What can I expect if I have this condition?

Uterine inversion can be life-threatening if it’s not managed correctly. The survival rate is excellent, though, with a care team that’s prepared for emergencies. People who receive this care go on to lead healthy lives with no long-term complications.

Can you get pregnant after a uterine inversion?

People with uterine inversion have gone on to have successful pregnancies. Still, more data is needed to understand what uterine inversion means for future pregnancies. Your provider should know if you have a history of uterine inversion. This information can help guide your care plan moving forward.

How do I take care of myself?

In addition to eating healthy, drinking plenty of fluids and getting as much rest as you can after a uterine inversion, take care to follow your provider’s guidance. Your home care will depend on how extensive your treatment was, how much blood you lost, etc. For instance, you may need to complete follow-up bloodwork or take iron supplements for blood loss. Follow your provider’s advice.

A note from Cleveland Clinic

It’s unlikely that you’ll experience uterine inversion. If you do, having a care team that provides treatment right away can save your life. Talk to your provider about any concerns you may have about emergency complications, like uterine inversion. Ask about the protocols in place to provide life-saving care if an emergency arises.