You've probably never heard of uterine inversion — and fortunately, that's because it's rare. When it does happen, it occurs right after delivery and is considered an obstetric emergency. The good news: With prompt treatment, most women recover quickly and go on to have healthy future pregnancies.
What is uterine inversion?
Uterine inversion happens when part of the uterine wall collapses and turns inside out, a bit like a sock being pulled inside out. In some cases, the uterus may even extend through the cervix and into the vagina.
Because this can cause heavy bleeding and shock, it requires immediate medical attention.
What causes uterine inversion?
Although the exact causes aren't completely understood, uterine inversion is often related to the placenta not fully detaching from the uterine wall. When the placenta comes out, it can pull the uterus with it.
The uterus is also more likely to invert if it's overly relaxed, or if the umbilical cord is pulled too hard during delivery.
Still, in many cases, there's no clear cause and nothing you could have done to prevent it.
Types of uterine inversion
There are four grades of uterine inversion, based on how far the uterus has turned inside out:
- Incomplete inversion: The top of the uterus has collapsed inward but hasn't come through the cervix.
- Complete inversion: The uterus is inside out and is coming out through the cervix.
- Prolapsed inversion: The uterus is visible in the vagina.
- Total inversion: Both the uterus and vagina are turned inside out. This is very rare.
About 90% of cases are complete or prolapsed. Most cases of inversion are acute uterine inversion, which means they happen within 24 hours of delivery.
How common is uterine inversion?
Uterine inversion is very uncommon. Studies show uterine inversion rates vary from 1 out of every 3,500 deliveries to as rare as 1 in 20,000.
Who is most at risk of uterine inversion?
Anyone can experience a uterine inversion, but certain factors can make it more likely:
- Delivering a very large baby (macrosomia)
- Having had a uterine inversion before
- Labor lasting more than 24 hours
- Several previous vaginal births
- Severe preeclampsia
- Use of medications that relax the uterus, such as magnesium sulfate (given to halt preterm labor)
- Placenta accreta (when the placenta grows too deeply into the uterine wall)
More than half of the time, however, uterine inversions happen without any risk factors.
What are the symptoms of uterine inversion?
Uterine inversion almost always happens immediately after birth. Symptoms can include:
- Sudden abdominal pain
- Excessive bleeding
- Signs of shock, like very low blood pressure
- A visible uterus in the vagina (in complete or prolapsed inversions)
Your healthcare team will be monitoring you closely during this time and will recognize symptoms right away. If needed, an ultrasound can confirm the diagnosis.
How is uterine inversion treated?
Treatment starts immediately and focuses on three things: returning your uterus to its normal position, stopping the bleeding, and preventing the inversion from happening again.
Your doctor may use one or more of the following approaches:
- Manual repositioning. This is the most common method and usually the first step. Your practitioner gently pushes the uterus back into place. You may receive a medication (through an IV) that relaxes the uterus to make it easier.
- Hydrostatic correction. If manual repositioning doesn't work, your provider may use a saline solution to create gentle water pressure that helps “inflate” the uterus back into position.
- Abdominal surgery. In rare cases, abdominal surgery is needed to correct the inversion.
“It only took them one time to put it back in when it happened, but it was really scary,” says What to Expect Community mom Chasityl94 about her uterine inversion.
Once your uterus is placed back where it belongs, you'll receive medications to help it contract normally and reduce the chances of it happening again.
You'll receive an antibiotic to prevent infection. Some women may need a blood transfusion if they had significant bleeding.
Unfortunately, even with prompt treatment, complications like postpartum hemorrhage can occur. About one-third of women may need a blood transfusion, and in about 3% of cases, an emergency hysterectomy is required if other treatments aren't successful. Fortunately, these situations are uncommon.
Keep track of your medications, postpartum symptoms, and more in the My Journal feature of the What to Expect app.
What to expect going forward
The outlook after a uterine inversion is overwhelmingly positive. Most women recover fully and go on to have healthy pregnancies in the future.
“I'm just entering my third trimester today,” says What to Expect Community mom kalisbalbi, who had a uterine inversion with her first birth. “We didn't have any trouble at all conceiving again (something I was very worried about).”
If you've had a uterine inversion before, let your provider know early in pregnancy so they can take precautions during delivery.
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