Uterine inversion

Liu Soo Kiun

Lau Fui Yii
Ng CHiat Haw
Uterine inversion
• Uterine inversion occurs when the uterine fundus collapses into the
endometrial cavity, turning the uterus partially or completely inside
out.
• It is a rare complication of vaginal or cesarean delivery, but when it
occurs, it is a life-threatening obstetrical emergency.
• If not promptly recognized and treated, uterine inversion can lead to
severe hemorrhage and shock, resulting in maternal death.
Classification
●1st degree inversion: the fundus
is within the endometrial cavity

● 2nd degree inversion: the

fundus protrudes through the
cervical os

● 3rd degree inversion: the fundus

protrudes to or beyond the
introitus

● 4th degree inversion: both the

uterus and vagina are inverted
Pathogenesis
• It has been attributed to use of excessive cord traction and fundal
pressure during the third stage of labor, especially in the setting of an
atonic uterus with fundal implantation of the placenta
Risk Factors
• Fetal macrosomia
• Rapid or prolonged labor and delivery
• Short umbilical cord
• Use of uterine relaxants,
• Nulliparity
• Uterine anomalies or tumors (leiomyoma)
• Retained placenta
• Placenta accreta
Management Goals
● Replace the uterus to its correct position

● Manage postpartum hemorrhage and shock, if

present

● Prevent recurrent inversion

Initial interventions
• Initial interventions
• Call for immediate assistance
• Establish adequate intravenous access and aggressive fluid
resuscitation
• Do not remove the placenta
• Immediately attempt to manually replace the inverted uterus
• Give uterine relaxants when immediate uterine replacement is
unsuccesful
• Reattempt manual replacement.
Manual replacement of uterine inversion (Johnson maneuver)

The inverted uterus is

replaced by placing a
hand inside the vagina
and pushing the fundus
along the long axis of
the vagina toward the
umbilicus.
Hydrostatic reduction

The patient is placed in reversed Trendelenburg

lithotomy position.

A bag of warmed fluid is hung at least one meter

above the patient and allowed to flow by gravity
or with light pressure through tubing connected
to a silastic ventouse cup in the vagina.
Surgical Intervention
• Huntington procedure

• Haultain procedure
Huntington procedure
In the Huntington procedure, the cup formed
by the inversion is located.

A clamp, such as an Allis or Babcock clamp, is

placed on each round ligament entering the
cup, about 2 cm deep in the cup.

Gently pulling on the clamps exerts upward

traction on the inverted fundus. Clamping and
traction are repeated until the inversion is
corrected.
Haultain procedure

The Haultain procedure for

management of uterine inversion
involves making an incision in the
posterior surface of the uterus to
bisect the constriction ring in the
myometrium, which is preventing
reduction of the inversion.