Which postpartum complication requires immediate assessment and possible surgical intervention when a cervix or uterus is at risk?

• A. Uterine inversion
• B. Endometritis
• C. Mastitis
• D. DVT

Answer: (A)

The key concept is recognizing a postpartum emergency where the uterus can turn inside out, posing life-threatening hemorrhage that requires rapid assessment and possible surgical correction. Uterine inversion occurs when the uterus is displaced through the cervix after delivery, leading to massive bleed and shock if not promptly managed. The priority is to stabilize the patient and restore the uterus to its normal position as quickly as possible. Manual replacement of the uterus through the vagina (gentle upward push to re‑institute normal anatomy) is performed immediately, avoiding any fundal pressure or traction on the umbilical cord that could worsen the inversion. After the uterus is repositioned, uterotonic medications are given to maintain uterine tone and prevent re-inversion, and vigorous fluid resuscitation with blood products may be necessary. If manual reduction cannot be achieved or bleeding continues, surgical intervention—such as a laparotomy to correct the inversion or, in severe cases, hysterectomy to control hemorrhage—may be required to save the patient’s life. The other conditions listed—endometritis, mastitis, and DVT—are managed with antibiotics, breast care, or anticoagulation, respectively, and do not involve the immediate, life-threatening need to reverse a uterus.