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Inverted Uterus

by Julie S. Moldenhauer, MD

Inverted uterus is a rare medical emergency in which the corpus turns inside out and protrudes into the vagina or beyond the introitus.

The uterus is most commonly inverted when too much traction is applied to the umbilical cord in an attempt to deliver the placenta. Excessive pressure on the fundus during delivery of the placenta, a flaccid uterus, or placenta accreta (abnormally adherent placenta) can contribute.


  • Manual reduction

Treatment is immediate manual reduction by pushing up on the fundus until the uterus is returned to its normal position. If the placenta is still attached, the uterus should be replaced before the placenta is removed. Because of discomfort, IV analgesics and sedatives or a general anesthetic are sometimes needed. Terbutaline 0.25 mg IV or nitroglycerin 50 mcg IV may also be needed.

If attempts to return the uterus are unsuccessful, a laparotomy may be necessary; the fundus is manipulated vaginally and abdominally to return it to its normal position. Once the uterus is in place, an oxytocin infusion should be started.

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