Abstract Uterine inversion is a rare case in obstetrics and gynecology field ,but the incident can be life threatening event. In the present case, a 19 year old women presented with total and acute uterine inversion after the delivery in peripheral hospital. She presented with fourth degree uterine inversion with the severe degree of hypovolemic shock with active vaginal bleeding. Immediate resuscitation along with simultaneous successful manual repositioning of uterus was done in the labour room. Medical management for atonic uterus was done. Despite of medical management uterus was atonic so uterine packing done. In view of persistent atonicity of uterus decision for emergency laporotomy were taken and patient was reffered to higher centre were she underwent subtotal hysterectomy with right internal iliac artery ligation. Postoperatively broad spectrum antibiotic and blood and blood product transfusion were done according to investigations. These findings suggest that proper management of 3rd stage of labour and early diagnosis and proper management will save the life of patient. Keywords: Uterine inversion; Atony; Hypovolemic shock; Manual uterine repostion.  Abstract Uterine inversion is a rare case in obstetrics and gynecology field ,but the incident can be life threatening event. In the present case, a 19 year old women presented with total and acute uterine inversion after the delivery in peripheral hospital. She presented with fourth degree uterine inversion with the severe degree of hypovolemic shock with active vaginal bleeding. Immediate resuscitation along with simultaneous successful manual repositioning of uterus was done in the labour room. Medical management for atonic uterus was done. Despite of medical management uterus was atonic so uterine packing done. In view of persistent atonicity of uterus decision for emergency laporotomy were taken and patient was reffered to higher centre were she underwent subtotal hysterectomy with right internal iliac artery ligation. Postoperatively broad spectrum antibiotic and blood and blood product transfusion were done according to investigations. These findings suggest that proper management of 3rd stage of labour and early diagnosis and proper management will save the life of patient.