Acute puerperal uterine inversion is a rare, potentially life-threatening complication of pregnancy. A dilated cervix with a relaxed uterus and simultaneous downward traction on the fundus are the possible factors leading to inversion of the uterus. The best way to manage the neurogenic component would be to reposition the uterus. The first-line procedure which is commonly used for manual replacement of uterus is referred to as Johnson's manoeuvre. Use of tocolytics in a situation where postpartum haemorrhage is a common accompaniment is fraught with danger. There are a few techniques which have been used during surgery to reduce the inverted uterus: Huntingdon's operation, Haultain's operation and hysterectomy. It is recommended to use an uterotonic drug in the initial phase of management after repositioning. Oxytocin infusion, misoprostol per rectum or prostaglandins can be used for this purpose.

Drugs used in obstetrics merit special mention because they have their effects on two patients rather than one. This chapter provides an understanding of the drugs commonly used by obstetricians, including drugs to increase uterine contractions, ergometrine, prostaglandins, tocolytics, atosiban, nifedipine, and beta2-adrenergic agonists. Oxytocin is a nonapeptide used to induce and augment labour and also to minimise post-delivery blood loss. The main use of tocolytics is to stop premature labour. They have also been used to facilitate delivery during Caesarean section by uterine relaxation and to treat uterine hyperstimulation, preventing fetal distress. Antihypertensive agents are widely used during pregnancy but they all cross the placenta and the available evidence does not always suggest that they are of benefit. Increasing the number of antenatal exposure of steroids is associated with reduced cognitive function, an increase in behavioural disorders and reduced birth weight.