The World of Pregnancy

Retroverted Uterus During Pregnancy: Causes, Symptoms & Diagnosis

Health is the most important aspect of our lives and our greatest goal – or at least it should be. Every woman tries to take care of her body, and in the perspective of a pregnancy, the health of the reproductive system is essential. Retroverted uterus during pregnancy is a serious matter that concern many women.

Retroverted Uterus during Pregnancy

What Is Retroverted Uterus?

Normally, the uterus is tilted afterward on the bladder, its position being named anteverted. This is the most common position of the uterus, but there`re certain women who have a different position of their uterus when it`s tilted posteriorly. In this case, we call the uterus retroverted. The retroversion of the uteus isn`t a disease and it usually isn`t incapacitating or alarming. According to statistics, it`s estimated that around 20% of women have retroverted uterus.

Causes

In most cases, retroverted uterus is congenital, but there might be other factors that lead to a change of its position in time. Here are a few important ones:

  • A pregnancy in which the ligaments have lost their elasticity, and they aren`t able to support the uterus after birth.
  • A fibroma which pulls the uterus back (toward the column), a fact most commonly encountered after the age of 40.
  • Sacral or pelvic surgery.
  • Endometriosis.
  • Chronic infections in the pelvic area.

Signs & Symptoms

There are a series of different symptoms that were associated with a retroverted uterus. Still, there lots of cases in which the woman show no symptom. The main signs are:

  • Pain during sexual contact or
  • Pain during menstruation or dysmenorrhea.
  • Minor incntinence.
  • Urinary tract infection.
  • Fertility issues.
  • Difficulties in using the tampons.

Read more on Pains During & After Sexual Intercourse!

Analyzes & Diagnosis

Na laborious investigations are needed to diagnose a retroverted uterus. A transvaginal ultrasound is quite efficient for this particular medical condition.

Diagnosis is done at a simple pelvic exam, the gynecologist being able to determine the position of the uterus quite easily. Also, the diagnosis of a retroverted uterus can also be made by ultrasound.

Retroverted Uterus during Pregnancy

In most cases, a retroverted uterus isn`t considered a cause of infertility, although if all other possible complication were excluded, an expert in fertility might recommend surgery to rectify the position of the uterus.

The ability of sperm to reach the uterus has nothing to do with its position. Having a retroverted uterus can be a normal anatomical variation, just like the color of the eyes or hair. – Read more!

Still, such a uterus may affect fertility in some way, because sperm may get a little harder in the uterus, but this may be influenced by choosing certain sexual positions during or after intercourse (e. g. the woman lying on her stomach).

Secondly, if the adhesions formed in the pelvic area have a retroverted uterus, they hinder the movement and flexibility of the uterus and fallopian tubes, and this may lead to the occurrence of difficulties in conception.

Starting with the weeks 10 – 12 of pregnancy, your uterus will no longer be tilted, and only in rare cases this doesn`t move in the middle position. In case this happens, then it`s possible for a miscarriage to occur. However, this rarely happens. – More info!

Treatment

Possible therapies for retroverted uterus with incarceration include the following:

  • Bladder decompression by catheter drainage.
  • The adoption of special position: knees to the chest, sleeping in the pronated position.
  • Manual uterine repositioning with/without tocolysis and anesthesia.

Bladder Decompression & Patient Position

The best initial treatment for symptomatic incarceration in the second trimester is bladder decompression combined with a special position of the patient. This treatment brings improvements in most situations. Spontaneous emptying is often impossible, and catheterization is necessary. If the bladder is distended, insert a catheter for 48 hours. If a urinary tract infection is present, appropriate treatment is initiated. During bladder drainage, the patient is instructed to perform repositioning exercises. They consist of adopting the genopathic position every 4 hours for 5 to 15 minutes, with intermittent valsalva maneuver. The patient is instructed to sleep in the pronated position (on the stomach). The spontaneous uterine replacement occurs normally after these steps.

Read more on Ovarian Cysts: Symptoms, Investigations, Complications & Treatment

Handling the Uterus

If the above maneuvers prove unsuccessful, a manual repositioning of the uterus is indicated. After an ultrasound, a tocolysis agent is given 15 minutes before reversion. Before the maneuver starts, the woman is instructed to urinate or put a Foley catheter. The patient is placed in a genphatic position. The surgeon inserts a finder into the vagina or rectum, and applies pressure on the incarcerated fundus while simultaneously applying lightweight constant thrusts on the cervix. This combined method will rotate the uterus in the normal position. The maneuver shouldn`t be too difficult for the surgeon or painful at all for the pregnant women. – More details!

After the procedure, the ultrasound will be repeated in real-time to evaluate the heart activity and fetal movements. The patient`s symptoms should soon diminish. She is instructed to adopt the genopathic position every 4 hours and sleep in the pronated position to maintain the position of the uterus.

Other Pelvic Malignant Syndromes

Allen-Masters Syndrome

For women who aren`t pregnant, the chronic pelvic pain evaluation that accompanies the retroverted uterus involves the suspicion of 2 different and complex syndromes: pelvic congestion and Allen-Masters syndrome.

Allen-Masters syndrome includes the following elements:

  • History of obstetric pelvic trauma.
  • Uterine retroversion with hypermobil cervix.
  • Cracks in the posterior and subperitoneal fascia of road ligaments.

The symptoms attributed to this syndrome are many and include menstrual disorders, chronic pelvic pain and dyspareunia. Although this cause has first been attributed to obstetric lesions, endometriosis and etiology are suspected. The classical therapeutic approach in these cases consists of the diagnosis established by laparotomy and laparoscopy. Any defects of the peritoneal ligaments are sutured.

Taylor`s Syndrome

Another possible diagnosis is Taylor`s syndrome. This medical condition is represented by menometroragia and signs of continuous pelvic pain. Upon examination, the uterus is soft and enlarged in volume, with a certain degree of sensitivity present. Uterine retroversion is common; the cervix may be cyanotic. Among other therapeutic options, hysterectomy and vascular embolization was used to control the syndrome. The signs are non-specific and poorly defined.

Is a Tilted Uterus Hereditary?

In many situations, a retroverted uterus is a genetical issue and something completely normal. However, there are also other distinct factors which may cause a retroverted uterus. Like mentioned above, some situations are caused by the labor of birth, endometriosis, pelvic inflammatory disease, pelvic surgery, fibroids or pelvic adhsesions.

Image courtesy of omicsonline.org
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