Risk Factor and Management of Puerperal Uterine Inversion: A Case Series

Puerperal uterine inversion is a rare yet life-threatening obstetric emergency that may lead to severe Postpartum Hemorrhage (PPH), whereas PPH remains a leading cause of maternal mortality. Prompt diagnosis and intervention are crucial to prevent fatal outcomes. We report three cases of puerperal uterine inversion managed at a tertiary teaching hospital in Indonesia between 2020 and 2024. Risk factors identified included multiparity, prolonged labor, baby birth weight >3000 gr, inadequate third-stage management including aggressive cord traction, history of misoprostol use, manual placenta and uterine atony. All cases were successfully managed with manual repositioning (Johnson's method) and intrauterine condom-catheter tamponade (average blood loss 983 mL), avoiding the need for hysterectomy. This combined non-surgical approach demonstrated high effectiveness in a low-resource setting. A critical finding was frequent misdiagnosis at primary care facilities contributed to delays in management. Strengthening birth attendant skills is crucial for preventing uterine inversion, immediate recognition and early intervention.