++
Uterine inversion is a rare complication of the third stage of labor but is potentially life-threatening. Although largely preventable, some occurrences are unavoidable. Prompt recognition and management are critical to reduce maternal morbidity and mortality rates, mainly due to hemorrhage.
++
The classification systems of uterine inversion are based on either the duration or magnitude of the inversion. Criteria are found in Table 31-1, and examples are seen in Figures 31-1 and 31-2 (Kitchin, 1975; Livingston, 2007; Pauleta, 2010; Watson, 1980; You, 2006). Most are acute and second- or third-degree inversions (Baskett, 2002; Brar, 1989; Dali, 1997; Morini, 1994; Platt, 1981; Shah-Hosseini, 1989; Witteveen, 2013).
++++++
++
The reported incidence of uterine inversion varies widely, which may be due to differences in definition, patient populations, and awareness and recognition. The reported incidence ranges from 1 in 500 to 1 in more than 57,000 deliveries (Baskett, 2002; Bunke, 1965; Das, 1940; Hostetler, 2000; Morini, 1994; Shah-Hosseini, 1989; Watson, 1980; Witteveen, 2013). Two single-institution reports that analyzed long epochs cite incidences of 1 in 1860 during cesarean delivery, 1 in 3737 during vaginal delivery, and 1 in 6403 in all delivery settings (Baskett, 2002; Shah-Hosseini, 1989). In a nationwide population-based study, the incidence was 1 in 20,000 vaginal births (Witteveen, 2013).
++
Previously, uterine inversion during cesarean delivery was considered rare (Chatzistamatiou, 2014; Witteveen, 2013). However, in one series, the incidence of inversion during cesarean delivery was actually twice that associated with vaginal delivery (Baskett, 2002). As one explanation, management of third-stage labor during cesarean delivery has varied over time and ranged from immediate manual extraction of the placenta to cord traction to promote ...