What's an inverted uterus? Here's what you need to know about 'one of the most serious complications of childbirth.'
Some people assume that pregnancy and childbirth will be a smooth experience, and in many cases it is. But a small number of women experience a serious and potentially deadly complication known as an inverted uterus, a uterus that folds in on itself.
Vesna Vavladellis is one of those women — she experienced a uterine inversion while giving birth to her first child in 2016. Vavladellis tells Yahoo Life that she was induced 40.5 weeks into her pregnancy, and things progressed quickly from there. "The labor was really intense — I felt like I couldn’t catch my breath," she says. Her son was born six hours later, but while she was delivering the placenta, Vavladellis says she suddenly experienced "excruciating pain."
"My ob-gyn was pushing really hard, and I noticed that there was a panic starting to settle," she says. "It was at this point that my uterus had inverted." Vavladellis was later told that her doctor was "frantically" trying to push her uterus back in, but it kept inverting — and she was bleeding heavily.
"I remember screaming and being in excruciating pain," she says, noting that she didn't have an epidural during labor. "I was feeling everything," she adds.
She remembers seeing how worried her husband looked and reassuring him that everything would be OK. "I don’t think I had realized the gravity of the situation," Vavladellis says. "I remember the nurses trying to get me to sign a document to consent to the surgery, and I was not in a state to at all. I asked my husband to sign on behalf of me."
Vavladellis went into emergency surgery for her uterus to be repositioned. "I was required to have a balloon inserted into my uterus to stop the hemorrhaging and to keep my uterus in," she says, noting that she was in the intensive care unit for 36 hours until the balloon could be removed.
Most people aren't aware that uterine inversion is a thing, and it's understandable to have questions about what, exactly, this is and why it happens. Here's what you need to know.
What is an inverted uterus?
An inverted uterus is "one of the most serious complications of childbirth," Dr. Jessica Shepherd, an ob-gyn in Texas and founder of Sanctum Med + Wellness, tells Yahoo Life. It happens when the fundus — the top part of the uterus — collapses into the uterine cavity. "It somewhat folds in on itself," Shepherd says. "It is relatively rare but when it happens carries a high risk of mortality due to hemorrhage and shock."
"Another way to think about it is the uterus gets turned inside out," Dr. Micah Garb, an ob-gyn at Lake Forest Hospital, tells Yahoo Life.
An inverted uterus can happen in a vaginal or C-section delivery, Dr. Michael Cackovic, a maternal-fetal medicine physician at the Ohio State University Wexner Medical Center, tells Yahoo Life.
Uterine inversion happens anywhere from every one in 3,500 to one in 20,000 deliveries, according to the Cleveland Clinic, and it usually occurs within the first 24 hours after delivery.
Why does an inverted uterus happen?
It's not completely understood why someone may experience an inverted uterus, Cackovic says. "Excessive pulling on the cord when delivering the placenta has been blamed," he says, adding that having the placenta attached to the top of the uterus may also play a role.
Other potential causes, according to Shepherd: a very fast labor, manual removal of the placenta, a short umbilical cord or use of uterine-relaxing drugs during delivery.
"However, evidence is inconsistent, and a causal relationship is unproven," Cackovic says. "It is likely that other factors play a role since spontaneous inversions occur and inversion is rare."
Symptoms of an inverted uterus
An inverted uterus can cause severe blood loss and shock, the Cleveland Clinic says. Symptoms can vary but may include:
Vaginal bleeding that may be mild or severe
Pain in your lower belly and a feeling of downward pressure
A smooth, round mass bulging from your vagina
Dropping blood pressure
According to the Cleveland Clinic, symptoms of shock can include:
Feeling dizzy, light-headed, weak, confused, tired or drowsy
Rapid heartbeat and shallow breathing
Cold and clammy skin
How is an inverted uterus treated?
A uterine inversion is serious. "When it occurs, it is a life-threatening emergency," Cackovic says. "If not promptly recognized and treated, uterine inversion can lead to severe hemorrhage and shock that can result in maternal death."
The goals of treatment are to return the uterus to its correct position while managing the bleeding and shock, he says. "After it is ensured that the placenta is separated, the uterus is replaced by manually pushing up on it to bring it back into the pelvis," Shepherd explains.
"If this is not successful, urgent surgery is the next step," Garb says.
Surgery typically involves a laparotomy, a procedure in which an incision is made in the abdomen to access the pelvic cavity and reposition the uterus, according to the Cleveland Clinic. Once the uterus is in place, patients may be given drugs to help it contract, reducing the risk that bleeding will continue and keeping the uterus in place.
Recovery can be tough
Vavladellis says her physical recovery was "extremely difficult. I often tell people it’s like I gave birth twice vaginally and [had] a C-section. I was not only recovering from a vaginal birth and a subsequent episiotomy, but I was also recovering from major surgery and healing an incision that was made to repair my uterus."
She was on "extremely heavy pain medication" for a long time and says that her pelvic floor was weak. "I was lying down a lot of the time because it was difficult to sit and made looking after my baby challenging," Vavladellis says. She ended up seeing a pelvic health therapist on a regular basis to help build up the muscles in her pelvic region.
Vavladellis says she was "really worried" when she found out she was pregnant with her second child because of her experience with a uterine inversion. "I remember seeing my best friend and telling her I was pregnant and just crying because I was afraid it would happen again," she says. "I was happy that I was having another baby, but I was scared."
Her doctor recommended that she have a C-section to be safe. Despite her fears, that delivery "was a breeze," she says. Vavladellis says she later realized that she had trauma from her first childbirth experience and sought help from a mental health counselor. Now, she says, "My health — physically, mentally and emotionally — is back on track."
People with a uterine inversion can go on to have a successful pregnancy, like Vavladellis did. However, if you experience an inverted uterus, experts say it's best to talk to your doctor about next steps to ensure you're as safe as possible moving forward.
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