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Uterine inversion is a life threatening obstetrical complication where instead of being delivered out of the vagina normally, the placenta clings to the uterus and pulls it inside out, dragging the fundus or top of the uterus towards the cervix. In rare cases, patients can experience a uterine prolapse, where the uterus actually enters the vaginal canal. Women who experience this complication can develop heavy bleeding and go into shock. Prompt intervention is needed to address this problem.
The biggest risk factor for a uterine inversion is a history of inversion with a prior pregnancy. Sometimes placental abnormalities can be associated with an inversion, especially if they are not recognized in time. This complication happens in about one in every 2,000 vaginal deliveries, making it relatively rare but still a cause for concern.
The immediate treatment for uterine inversion is intravenous delivery of fluids and blood to keep blood volume high and prevent the patient from going into shock. A care provider will attempt to manually push the uterus back into place and deliver the placenta if it has not been completely delivered. If the uterus resists repositioning, surgery may be necessary to reposition it and stabilize the patient.
Once the uterus is back in place, women are given medications to encourage the uterus to firm up, and the uterus may be gently kneaded or massaged to promote the tightening down that normally happens after delivery. This will address the bleeding and make the patient more comfortable. Care providers will also check to confirm that the uterus is staying in place, and the woman will be told to rest and drink lots of fluids when she gets home. If a woman experiences symptoms like heavy bleeding or pelvic pain at home after a uterine inversion, she should call her doctor to determine if she needs to return to the hospital for treatment.
Delivery teams are very well trained. They are prepared to deal with obstetrical complications and emergencies and can swing into action very quickly. While making a birth plan, couples should be prepared for the fact that an emergency may derail a plan, as the most important thing in the delivery room is the health of mother and child. It is also important to be aware that in an emergency like a uterine inversion, care providers may not have time to explain procedures in detail because they need to act quickly. It can be helpful to sit down with care providers ahead of time to learn about potential emergencies and how they will be handled so people will understand what is going on and be better prepared in an emergency.