The main symptom of uterine inversion is?

RML PRE 2025

Obstetrics & Gynaecology

Easy

Appeared in: RML PRE 2025

Explanation

Uterine inversion is a life-threatening obstetric emergency where the uterus turns inside out, typically during the third stage of labor.
The primary and most critical clinical presentation is severe hemorrhage leading to profound shock.
The shock is often disproportionate to the initial blood loss due to a neurogenic component from pain and peritoneal stretching, which is then compounded by hypovolemic shock from massive bleeding.
Immediate recognition and management are crucial for maternal survival.

Option A: While severe lower abdominal pain with a bearing-down sensation is a classic symptom, the word 'only' makes this option incorrect. The most life-threatening features are hemorrhage and shock.
Option B: Absence of lochia is not a symptom of uterine inversion. Lochia is the normal vaginal discharge after childbirth and would be expected to be present and mixed with heavy bleeding.
Option D: A cervical tear is a separate type of birth canal injury. Although it can also cause postpartum hemorrhage, it is a distinct diagnosis and not a symptom of uterine inversion.

Clinical Relevance

Nursing practice connection: Knowing Clinical Manifestations of Uterine Inversion helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Uterine inversion is a top-tier obstetric emergency. The nurse's ability to quickly recognize the signs (hemorrhage, shock, a missing uterine fundus on abdominal palpation) and initiate an emergency response is vital for patient survival.
Key nursing actions include calling for help (obstetrician, anesthesia), establishing large-bore IV access for massive transfusion protocols, and preparing for immediate uterine replacement.
What if? If the placenta is still attached to the inverted uterus, it should NOT be removed until after the uterus is repositioned. Attempting to remove the placenta first will cause catastrophic hemorrhage.

How to Approach the Question

First, identify the core concept of the question: uterine inversion. Recognize this as a severe obstetric emergency.
The question asks for the 'main' symptom. This directs you to identify the most significant, life-threatening, and characteristic feature of the condition.
Evaluate each option based on your knowledge of postpartum complications.
Option A: 'Severe abdominal pain only'. The word 'only' is a qualifier that often makes an option incorrect. While pain is present, it's not the sole or most dangerous symptom.
Option B: 'Absence of lochia'. This is physiologically incorrect in the immediate postpartum period.
Option C: 'Severe haemorrhage with shock'. This aligns perfectly with the definition of uterine inversion as a hemorrhagic catastrophe.

Concept Tested & Keywords

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 1-5

E6 Obstetrics Williams p. 52-72