Acute Uterine Inversion

‘The child was born about an hour before I came, and the midwife in attempting to bring away the placenta, had inverted the uterus; for upon examination, I found the whole body of the uterus with the placenta, adhering to the fundus, hanging out beyond the labia; there was a great profusion of blood, and the woman was dead before I came … This case should be a caution to all practitioners how they attempt to bring away the placenta, and not to pull the string too rudely, lest they invert and draw out the uterus, by which the woman dies a martyr to their temerity and ignorance, as was too plainly the case in the precedent observation’.

• William Giffard

• Cases in Midwifery. London: Motte; 1734:421–422.

Acute uterine inversion is a rare but life-threatening complication of the third stage of labour. The incidence varies widely between 1 in 2000 and 1 in 50,000 deliveries, largely dependent upon the standard of management of the third stage of labour. Acute uterine inversion occurs within 24 hours of delivery; subacute between 24 hours and 4 weeks of delivery; and chronic uterine inversion presents after 4 weeks or in the nonpregnant state. Cases of subacute and chronic uterine inversion may require surgical management. This chapter deals with acute uterine inversion.