Key content:• Acute uterine inversion is a rare and unpredictable obstetric emergency.• Mortality and morbidity are reduced by early recognition and management. • Shock and uterine replacement must be addressed simultaneously.• The importance of teamwork cannot be overemphasised.• There is a need for skills and drills training because of the rarity of acute inversion. Learning objectives:• To understand the pathophysiology.• To understand and to be able to evaluate critically the general management principles. Ethical issues:• Management of uterine inversion is guided by a relatively small evidence base, resulting in treatment modalities being used without proper evaluation.

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