Emergent obstetric management of uterine inversion

Puerperal inversion of the uterus is an unusual and potentially life-threatening event occurring in the third stage of labor, but when managed promptly and aggressively inversion can result in minimal maternal morbidity and mortality. Once the diagnosis of inversion is made, measures should be undertaken to manage and correct acute blood loss and potential shock. In conjunction with anesthesia personnel, immediate uterine replacement should be considered. Uterine relaxants (MgSO4, terbutaline, or halothane) can be used if initial attempts fail; however, in the majority of patients successful immediate replacement without use of uterine relaxants is possible. The choice of anesthetic agent and uterine relaxants should be individualized based on the clinical scenario. Following manual replacement, massage and ecbolic agent(s) should be instituted immediately to prevent reinversion. Surgical repositioning via an abdominal or vaginal approach may be necessary in subacute or chronic inversions.