What question did this study set out to answer?

This study aims to identify risk factors and effective management strategies for puerperal uterine inversion in cases of postpartum hemorrhage.

May 9, 2026Open Access

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

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Puerperal uterine inversion (n=3). Intervention: Manual repositioning (Johnson's method) and intrauterine condom-catheter tamponade. Primary outcome: Successful management without the need for hysterectomy.

Key Result

Manual repositioning using the Johnson method combined with intrauterine condom-catheter tamponade successfully managed puerperal uterine inversion in all three cases, avoiding hysterectomy.

Key Points

This study aims to identify risk factors and effective management strategies for puerperal uterine inversion in cases of postpartum hemorrhage.
Case series of three instances managed in a tertiary teaching hospital between 2020 and 2024.
Interventions included manual repositioning using Johnson's method and intrauterine condom-catheter tamponade.
Focused on identifying risk factors such as multiparity and prolonged labor.
All three cases were effectively managed with minimal blood loss, averaging 983 mL.
Risks included multiparity and aggressive cord traction, leading to timely interventions.
Misdiagnosis at primary care facilities was noted, leading to management delays.

Study Design

Type

Case Report (n=3)

Multicenter

Structured PICO

Does manual repositioning combined with intrauterine condom-catheter tamponade successfully manage puerperal uterine inversion?

Population

3 cases of puerperal uterine inversion managed at a tertiary teaching hospital in Indonesia between 2020 and 2024

Intervention

Manual repositioning (Johnson's method) and intrauterine condom-catheter tamponade

Outcome

Successful management avoiding hysterectomy

Manual repositioning combined with intrauterine condom-catheter tamponade is an effective non-surgical approach for managing puerperal uterine inversion in low-resource settings.

Limitations

Small sample size inherent to a case series of a rare condition
Condom catheters cannot be filled with more than 250-300 mL of fluid due to rupture risk
Condom catheter texture does not allow for efficient compression of the uterine cavity compared to Bakri balloons

Abstract

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.

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