Uterine inversion is most commonly caused by which action?

• A. Retained placenta
• B. Placental abruption
• C. Pulling on the umbilical cord and excessive fundal massage
• D. Uterine rupture

Answer: (C)

Uterine inversion happens when the uterus turns inside out after delivery, and the most common trigger is pulling on the umbilical cord before the placenta has delivered, often along with excessive fundal massage. When the placenta is still attached and the uterus is contracting, applying strong traction or fundal pressure can pull the fundus down through the cervix and into the vaginal canal, effectively inverting the uterus. This is an obstetric emergency because it can rapidly cause massive hemorrhage and shock.

The other scenarios don’t typically cause inversion. Retained placenta is a consequence after delivery when the placenta doesn’t separate, not a mechanism that inverts the uterus. Placental abruption involves premature separation of the placenta from the uterus and isn’t the process that flips the uterus inward. Uterine rupture is a tear in the uterus, usually from scar tissue or severe trauma, and while dangerous, it’s a different pathology than inversion.