The classic presentation is sudden postpartum hemorrhage, severe pelvic or lower abdominal pain, shock, and an absent or abnormal uterine fundus. A vaginal mass may be visible or palpable. The patient may describe intense pelvic pressure, a sensation that “something is coming out,” or sudden severe pain after placental delivery. Sign or Symptom Mechanism Sudden heavy vaginal bleeding The uterus cannot contract effectively around the placental site. Severe pelvic, abdominal, or vaginal pain Uterine traction, tissue stretching, and cervical constriction stimulate pain fibres. Absent fundus on abdominal palpation The fundus has descended inward instead of remaining in the abdomen. Vaginal or introitus mass The inverted fundus may protrude through the cervix or outside the vagina. Hypotension, tachycardia, pallor, diaphoresis Hemorrhage and sympathetic compensation. Shock that seems disproportionate to visible bleeding Vagal stimulation from uterine and pelvic tissue stretch may worsen collapse. Persistent bleeding despite uterotonics Uterotonics cannot correct the mechanical problem if the uterus remains inverted. Anxiety, restlessness, confusion, altered level of consciousness Cerebral hypoperfusion from shock. StatPearls emphasizes that uterine inversion is a clinical diagnosis and should be suspected...