The uterus is most commonly inverted when too much traction is applied to the umbilical cord in an attempt to deliver the placenta. The following conditions can contribute:
Excessive pressure on the fundus during delivery of the placenta
A flaccid uterus
Placenta accreta (abnormally adherent placenta)
Diagnosis of an inverted uterus is clinical.
Treatment of an inverted uterus 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 is sometimes needed. Terbutaline 0.25 mg IV or nitroglycerin 50 mcg IV may also be needed.
The fundus is manipulated vaginally and abdominally to return it to its normal position. Once the uterus is in place, women should be given a uterotonic drug (eg, oxytocin infusion) to reduce the likelihood of reinversion and hemorrhage.
If attempts to return the uterus are unsuccessful, a laparotomy may be necessary.