Uterine Inversion

Finding Mechanism Sudden heavy vaginal bleeding The uterus cannot contract normally around placental blood vessels. Severe pelvic, lower abdominal, or vaginal pain Uterine tissue and pelvic structures are stretched and displaced. Shock, pallor, dizziness, syncope, altered level of consciousness Hemorrhage and vagal stimulation reduce perfusion. Hypotension and tachycardia Compensatory response to blood loss; bradycardia may occur with vagal response. Fundus not palpable abdominally The fundus has inverted downward and is no longer in its normal abdominal position. Red-purple mass visible or palpable in vagina The inverted fundus may protrude through the cervix into the vagina. Ongoing bleeding after placental delivery or during attempted placental delivery Placental site vessels remain open and poorly compressed. Retained or attached placenta Placenta may still be attached to the inverted fundus. The classic exam clue is: postpartum hemorrhage + shock + absent fundus on abdominal palpation + vaginal mass = suspect uterine inversion. For REx-PN (Canada), items rarely announce the topic in the first sentence. Anchor to objective data, trajectory, and the safest next step for the role named in the stem before distractors compete.