Occasionally teleports and reappears elsewhere. Slowly floats towards Isaac and fires a blood shot at him. While in the Utero, a dark yellowish desaturated screen shader and a warping effect will be applied to the screen, making it appear as if the area is submerged in fluid and further distinguishing the floor's appearance from the Womb. Like the Womb, all damage that is taken on this floor and onwards deducts a full heart from the player's health (unless the player has The Wafer), regardless of the source. Its walls are slightly different, and the floor contains several new enemies that are bloodier and more deformed, as well as more enemies borrowed from later chapters, such as the Cathedral and Sheol. While the theme of Utero overlaps heavily with the Womb, it appears to emphasize gore and disfigurement rather than its counterpart's focus on 'intact' viscera, though the difference in enemy make-up is still more subtle compared to other floors nonetheless. Unlike other alternate floors, the Utero does not need to be unlocked, aside from unlocking the Womb. The Utero is an alternate floor to the Womb.
