Uterine Inversion

Uterine inversion is a rare cause of postpartum hemorrhage in which the uterine fundus inverts through the cervix into the vagina.^[274] Hypotension usually results before significant blood loss has occurred. Treatment of uterine inversion should include fluid therapy for the mother and restoration of the uterus to its normal position. Uterine relaxation may be necessary to replace the uterus; β-sympathomimetic agents, magnesium, and nitroglycerin have all been used to achieve this goal. The choice of agent may be dependent on the mother's hemodynamic stability. For example, in the case of profound maternal hypotension, magnesium sulfate may be a better choice than nitroglycerin. Should initial efforts to replace the uterus prove unsuccessful, rapid-sequence induction with cricoid pressure and endotracheal intubation should be undertaken.