Apparently Your Uterus Can Fold In On Itself During Delivery
Yep, it's as terrifying as it sounds. Two OB-GYNs gave us the scoop on this serious birth complication.
You don’t need us to tell you that even under the smoothest circumstances, giving birth is still scary as sh*t. And while plenty of things can (and sometimes do!) go wrong along the way, moms on TikTok are sharing the traumatic experience of uterine inversion — aka a very real, very serious complication that happens when the uterus folds in on itself — and it’ll have you wincing and fully clutching your abdominal area, feeling phantom pains.
With a whopping 10 million views and counting, #uterineinversion underscores the rare complication that can occur during or after delivery of the placenta when the top of the uterus (aka the fundus) prolapses into the uterine cavity, as two OB-GYNs tell Scary Mommy.
So, if you’re currently pregnant or would like to be sometime in the future, you’re likely wondering how and why this happens. And how common is it, really? Here’s everything you need to know about this little-discussed medical condition.
How and why does this happen?
First things first: Take solace in knowing that a uterine inversion (aka an inverted uterus) is, indeed, rare. The National Institutes of Health (NIH) estimates it occurs anywhere from every one in 2,000 to one in 20,000 deliveries, as Dr. Jill Purdie, board-certified OB-GYN and medical director at Pediatrix Medical Group, points out. According to the Cleveland Clinic, it usually occurs within the first 24 hours after delivery.
Essentially, it occurs when the fundus folds into the lower part of the uterus or even through the cervix into the vagina, says Purdie. If it sounds terrifying, that’s because it kind of is. But there are plenty of signs and symptoms that will alert you if something isn’t right, at which time you’ll receive immediate emergency care — more on that in a minute.
Even scarier, “the majority of the time, this condition occurs unexpectedly,” says Purdie. “The best theory on why it occurs is that the placenta is attached to the fundus of the uterus, and when traction is placed on the umbilical cord to help remove the placenta, it pulls the uterus down, inverting it. This is more likely to occur if the placenta is adherent (stuck too well) to the inner surface of the uterus.”
“Some known risk factors include a fast delivery, a short umbilical cord or traction on the cord or placenta during removal, abnormalities in the placenta, or an over-distended uterus,” says Stephanie Brownridge, MD, a New York-based fertility physician at Shady Grove Fertility. “One of the most important risk factors is a history of uterine inversion in a previous birth, though most often it is a one-time occurrence.”
The most common symptoms include pain and feelings of fullness/pressure, significant vaginal bleeding, and shock, note both experts. A physical exam by your midwife, physician, or another healthcare provider will confirm if it is, in fact, an inverted uterus, with Purdie adding that “generally, a mass is felt in the cervix or vagina and the uterus is unable to be felt through the abdomen.”
How serious is it?
“Uterine inversion is an emergency,” says Brownridge. “Fortunately, it can be treated quickly, especially when childbirth takes place in a hospital.” Purdie adds: “A uterine inversion requires immediate replacement of the uterus as well as resuscitation of the mother with fluids and blood.”
Both doctors note that not every case requires surgery, but immediate medical attention is paramount. “In many cases, the uterus can be manually replaced by the physician,” says Purdie. “This typically requires giving medication to relax the uterus and the physician pushing the uterus back right side out. Once the uterus is replaced, medications to contract the uterus are given; sometimes, a balloon may be placed to keep the uterus in the correct position. If a manual replacement is not possible, surgery may be required to correct the inversion.” Brownridge adds: “The goal of surgery is to restore the uterus into its proper position.”
If you suspect it’s happening to you and you’ve given birth outside a hospital, both doctors emphasize seeking emergency services as soon as possible. “Uterine inversion becomes life-threatening when heavy blood loss occurs,” says Brownridge. “However, this is more of a concern outside the hospital setting. If it occurs after a vaginal delivery, the first step is to treat the inversion manually without surgery. If that is unsuccessful, the next step is surgery to treat the inversion.”
What does recovery look like?
“Recovery from uterine inversion depends on the severity,” says Brownridge. “If promptly treated with minimal intervention, then recovery mainly involves observation to ensure vital signs are stable,” and the patient will receive pain medication when needed. In the case of surgery or severe blood loss, “recovery can last a few days where close monitoring and pain control are needed.”
Thankfully, there is some good news here. “Long-term complications after recovery are uncommon,” says Brownridge. “While there is a risk of uterine inversion happening again in a future delivery, the majority of women go on to have healthy pregnancies and deliveries.” However, Purdie notes that concrete data is limited on how often repeat uterine inversions occur.
As with any pregnancy or delivery concerns, Brownridge recommends checking in with your doctor to assess your specific risks and come up with solutions that will keep your health and safety top of mind. And rest easy knowing that this nightmare scenario is very unlikely to happen to you, no matter what fresh terror TikTok hath wrought these days.