• Is mostly seen in puerperium
• Etiology -
  • Spontaneous - unknown cause
  • Due to traction applied to the umbilical cord when placenta is morbidly adherent OR
  • Squeezing a relaxed uterus immediately after delivery
• Clinically, it is associated with severe degrees of shock and it bleeds profusely
• Treatment -
  • Immediate replacement of the uterus is the ideal treatment
  • Resuscitation of the patient should be simulatneous (due to shock)
  • Method of replacement
    • If it occurs in presence of doctor or nurse - reposition by exerting firm and constant pressure on the inverted uterine fundus. If placenta is still attached, it should not be removed till reposition is complete
    • If it occurs in domiciliary midwifery -
      • O'Sullivan's technique is used.
      • If it fails, manual reposition under General anaesthesia.
      • If it fails, abdomen opened, inverted uterus pulled back with simultaneous pressure from outside on vagina. Sometimes, tight cervical ring may need division & repair following successful reposition
      • Total abdominal hysterectomy - if patient old and family completed.

Chronic inversion -

• occurs in late puerperium
• Etiology
  • in those cases in whom initial stages of inversion has been overlooked in early stages OR
  • those which are associated with submucous fibroid of the fundus
•  Clinically, the patient complains of
  • Intermittent lower abdominal pain
  • Irregular vaginal bleeding
  • Offensive blood stained discharge - when infection sets in