During controlled cord traction in the third stage, the fundus suddenly rises above the umbilicus and the cervix is seen bulging with an inverted uterine fundus at the introitus. Heavy bleeding begins. The immediate management is:
- A Pull the cord firmly while applying suprapubic pressure
- B Manually push the fundus back through the cervix without delay, using hydrostatic reduction if needed ✓
- C Administer a bolus of oxytocin and attempt repositioning after contraction
- D Apply a vaginal pack and defer correction until the patient stabilizes over 24 hours
Correct answer: B. Manually push the fundus back through the cervix without delay, using hydrostatic reduction if needed
Explanation
Acute uterine inversion is an obstetric emergency managed by immediate manual replacement of the fundus through the dilated cervix, ideally before cervical constriction rings form, with hydrostatic (O'Sullivan) reduction or uterine relaxants such as terbutaline if manual effort fails. Traction on the cord worsens the inversion, oxytocin before replacement tightens the constriction ring, and delayed packing risks shock and sepsis without correcting the mechanical problem.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.