Facts

-Collapse of the uterine fundus into the endometrial cavity turning the uterus partially or completely inside out.

-A rare complication of vaginal delivery

-An obstetrical emergency.

-If not promptly recognized and treated, uterine inversion can lead to severe hemorrhage and shock

-The most common disorder in differential diagnosis: Prolapsed fibroid

-Diagnosis:

-Key finding: On abdominal examination, lack of palpation of a normally positioned fundus.

-Ultrasound, CT, MRI

-Treatment: Manage postpartum hemorrhage and shock, if present using volume resuscitation, blood transfusion, Discontinue uterotonic drugs (oxytocin), give uterine relaxants (nitroglycerin,Terbutaline, Sevoflurane, Desflurane, Isoflurane), do not remove the placenta, immediately attempt to manually replace the inverted uterus to its normal position, Place a hand inside the vagina and push the fundus along the long axis of the vagina toward the umbilicus (Johnson maneuver). If these measures fail, consider surgery (Huntington procedure, Haultain procedure)