Overview
Overview
Minutes after birth, a patient may suddenly report severe pelvic pressure or pain, while bleeding increases and the uterus can no longer be felt in its expected abdominal position.
Minutes after birth, a patient may suddenly report severe pelvic pressure or pain, while bleeding increases and the uterus can no longer be felt in its expected abdominal position. A rounded mass may appear in the vagina. This pattern signals that the uterus has displaced inward, not simply that it has become atonic. Because the inverted uterus cannot compress the placental bed effectively, hemorrhage can progress at the same time as vagal-mediated shock. Treat the situation as an obstetric emergency: call the team, begin resuscitation, and prepare for immediate manual replacement. The attached placenta remains in place until reduction unless the responsible obstetric clinician directs otherwise. Once the uterus is restored, management changes from replacement to contraction, hemorrhage control, and surveillance for reinversion.