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Acute inversion of the uterus

^1. Department of Obstetrics and Gynaecology, Royal London Hospital, Whitechapel Road, London E1 1BB, UK Email: vinnybhalla{at}gmail.com (corresponding author)
^2. Department of Obstetrics and Gynaecology, Homerton University Hospital NHS Foundation Trust, Homerton Row, London E9 6SR, UK
^3. Department of Obstetrics and Gynaecology, Whipps Cross University Hospital NHS Trust, Whipps Cross Road, Leytonstone, London E11 1NR, UK
^4. Department of Obstetrics and Gynaecology, Royal London Hospital, London, UK

Key content:

• Acute uterine inversion is a rare and unpredictable obstetric emergency.
  
• Mortality and morbidity are reduced by early recognition and management.
  
• Shock and uterine replacement must be addressed simultaneously.
  
• The importance of teamwork cannot be overemphasised.
  
• There is a need for skills and drills training because of the rarity of acute inversion.
  

Learning objectives:

• To understand the pathophysiology.
  
• To understand and to be able to evaluate critically the general management principles.
  

Ethical issues:

• Management of uterine inversion is guided by a relatively small evidence base, resulting in treatment modalities being used without proper evaluation.
  

Please cite this article as: Bhalla R, Wuntakal R, Odejinmi F, Khan RU. Acute inversion of the uterus. The Obstetrician & Gynaecologist 2009;11:13–18.

Keywords manual replacement / postpartum haemorrhage / surgical management / tocolysis