Uterine Inversion

Uterine inversion is a rare and serious childbirth complication where your uterus turns inside out. Instead of maintaining its normal shape after delivery, your uterus collapses inward. It may even fall outside your vagina. It can cause severe blood loss, shock and possible death. A prepared care team that acts quickly can prevent these outcomes.

Most often, it occurs within the first 24 hours of delivery. In extremely rare cases, it happens for a reason other than childbirth.

Symptoms of uterine inversion

Uterine inversion is a medical emergency. Symptoms can vary, depending on how extreme the inversion is. Some of those symptoms are:

• Severe vaginal bleeding
• Pain in your lower belly and a feeling of downward pressure
• A smooth, round mass bulging from your vagina
• Dropping blood pressure

You can also show signs of shock from losing too much blood. Symptoms could include:

• Dizziness
• Weakness or tiredness
• Rapid heartbeat
• Shallow breathing
• Cold and clammy skin

Uterine inversion causes

Uterine inversion can sometimes happen after birth, when the placenta is being delivered. This process usually doesn’t cause any issues. But in rare cases, inversion can occur if you have certain risk factors that make it more likely.

Potential risk factors for uterine inversion are:

• Short umbilical cord
• Placenta accreta
• Rapid or prolonged labor and delivery
• Use of medicines that relax your uterus
• First time giving birth
• Uterine atony
• A fetus that’s bigger than average (fetal macrosomia)
• Retained placenta
• Using fertility treatments to get pregnant
• Prior uterine surgeries
• Prior uterine inversion

How doctors diagnose uterine inversion

Your healthcare provider may be able to diagnose an inversion 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. They’ll also watch your vital signs to see if your blood pressure is dropping.

Diagnosis has to happen quickly so that lifesaving treatment can begin immediately.

What are the degrees of uterine inversion?

The four types are:

• 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.

Most uterine inversions fall into the 2nd- or 3rd-degree categories.

How is it 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 give you anesthesia to keep you pain-free, check your blood levels, deliver blood transfusions and assist your provider.
• Manual reinsertion of your uterus: Your provider may try to gently push the top of your uterus back into place. 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 provider can’t put your uterus back 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.
• Hysterectomy: This is usually a last resort if the bleeding won’t stop or your uterus can’t be repositioned.

What can I expect if I have this condition?

Uterine inversion can be life-threatening if your healthcare team can’t manage it. The survival rate is excellent, though, with a care team that’s prepared for emergencies. You can go on to lead a healthy life with no long-term complications.

Can you get pregnant after a uterine inversion?

Yes. You should tell your provider if you have a history of uterine inversion. This can help guide your care plan during a future pregnancy and delivery.

Is uterine prolapse the same as an inversion?

No. While both involve your uterus shifting or moving, an inversion means your uterus is collapsing or inside out. It’s a rare, life-threatening emergency that happens after childbirth. A prolapse is when your uterus slips down into your vagina. It can be severe, but it’s not life-threatening.