Uterine Inversion

Uterine inversion is a postpartum structural emergency: the uterine fundus collapses inward and may descend through the cervix into the vagina. The fastest recognition pattern is sudden bleeding plus an absent or displaced abdominal fundus, severe pelvic pain, syncope, or a red-purple vaginal mass. Treat this combination as inversion until the obstetric team proves otherwise. Call emergency help, support circulation, hold uterotonics, avoid fundal pressure, cord traction and placental removal, and prepare for immediate Johnson/manual reduction; routine fundal massage is the wrong response when the fundus is inverted. Hold one mental model through the whole emergency: shape first, squeeze second. A uterus controls bleeding by contracting around open vessels, and an inside-out uterus cannot do that. Contraction before replacement tightens the ring the fundus must pass back through, so the drugs that rescue an atonic uterus get in the way here. Once the shape is restored, those same drugs hold it in place and close the vessels.