What is a uterine inversion?
Uterine inversion is a serious but rare complication of childbirth in which the uterus literally turns inside out after the baby is delivered. When this happens, the top of the uterus (the fundus) comes through the cervix or even completely outside the vagina. It occurs in about 1 in 3,000 births.
Normally, after a vaginal birth, contractions cause the placenta to separate from the wall of the uterus. This typically happens within five to ten minutes after you give birth, though it may take longer. As long as you’re not bleeding, your doctor or midwife can wait a while for the placenta to separate on its own.
(If the placenta doesn’t separate on its own, your practitioner will do what’s known as a manual removal of the placenta, which involves reaching up through your vagina and into the uterus with one hand and “peeling” the placenta away from the uterine wall.)
After your caregiver sees signs that the placenta is separating, she may ask you to gently push to help expel the placenta out of your uterus and through the vagina. She may help guide the placenta out of the vagina by gently pulling on the umbilical cord.
Sometimes, a placenta doesn’t separate normally, and attempts to deliver it cause a uterine inversion. It’s possible for a uterine inversion to happen on its own, too.
A uterine inversion can cause serious problems, including life-threatening bleeding and shock, particularly if it’s not recognized and treated immediately.
How is it treated?
Your doctor or midwife will try to reposition your uterus and push the fundus back through the cervix.
If you don’t already have an IV, one will be started immediately. You’ll be given medication to control the pain and drugs to relax your uterus, which helps your caregiver reposition it. Occasionally, abdominal surgery is necessary to return the uterus to its original position.
Once your uterus has been repositioned, the drugs that were used to relax the uterus will be stopped. You’ll be given a continuous IV infusion of oxytocin to firm up your uterus, help it stay where it belongs, and control bleeding. Until your uterus firms up, your caregiver will apply pressure to it with one hand inside your vagina and the other on your belly to compress the uterus and slow the bleeding.
Your medical team will continue to watch you closely. They’ll check your uterus to be sure it remains in position and monitor your vital signs and vaginal bleeding. You’ll get blood transfusions as needed and will likely be given antibiotics to prevent infection. You’re apt to feel weak and lightheaded, and at first you shouldn’t try to get out of bed on your own.
Once you’re home, you’ll need to take good care of yourself. Make sure you get lots of rest, eat nutritious meals, drink plenty of fluids, and follow any other instructions from your caregiver to the letter. (You’ll be told to take iron supplements, for example.)
What you need to know for future pregnancies
Once you’ve had one uterine inversion, you’re more likely to have another one. As with any pregnancy complication or other medical problem, be sure your doctor or midwife is aware of your history. This gives your caregiver a chance to prepare for the possibility of another inversion by making sure you have an IV running and an anesthesiologist immediately available, if needed, for your delivery.