1. INVERSION OF THE UTERUS

2. DEFINITION
It is a condition in which uterus is turned inside out partially or completely
Life threatening complications in the third stage of labour

4. TYPES FIRST DEGREE Dimpling of the fundus
Uterus remains above the level of internal os
SECOND DEGREE
Fundus passes through the cervix
But lies inside the vagina
THIRD DEGREE
Endometrium with or without the attached placenta is visible outside the vulva
The cervix and part of the vagina may also be involved in the process

6. ETIOLOGY SPONTANEOUS Localised atony of the placental site
Sharp rise of intra abdominal pressure
Short cord
Placenta accreta
INDUSED
Mismanagement of third stage
Pulling the cord
Crede’s expression
Faulty technique in manual removal

8. DANGERS SHOCK Tension on the nerve Pressure on the ovaries
Peritoneal irritation
HAEMORRHAGE
PULMONARY EMBOLISM
INFECTION
UTERINE SLOUGHING
CHRONIC

9. DIAGNOSIS SYMPTOMS Lower abdominal pain with bearing down sensation
SIGNS
Shock
Cuppling or dimpling at the fundus
Fundus cannot be made out
A reddish purple pear shaped mass protrudes outside the vulva

10. PREVENTION Do not expel placenta when uterus is relaxed
Pulling the cord simultaneously with fundal pressure should be avoided
Manual removal should be done with caution

11. MANAGEMENT Before shock Urgent manual removal even without anaesthesia
To replace that part first which inverted last
To apply counter support with other hand placed on the abdomen
Hand should remain inside until the uterus becomes contracted
Placenta is to be removed manually only after the uterus becomes contracted
Treatment for shock

13. Contd… After the shock Treatment of shock Push the uterus inside
Pack the vagina with antiseptic roller gauze
Raise the foot end of the bed
Replacement of the uterus