The World of Pregnancy

Retroverted Uterus During Pregnancy: Causes, Symptoms & Diagnosis

Did you know that depending on the source, there are either 1 in r or 1 in 5 women with a retroverted uterus, also known as a tipped uterus, retroflex uterus or tilted uterus?

Retroverted Uterus during Pregnancy

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. A retroverted uterus during pregnancy is a serious matter that concern many women.

What Is a Retroverted Uterus?

The uterus is a cavity with a shape of overturned pear. The average length is of 6 to 8 cm, and the average length is of 3 – 4 cm. Its walls are externally formed from thin muscle tissue, while inside is lined with a mucosa known as endometrium. This mucosa, designed to host the fertilized egg, rich in gnadular structures and blood vessels, undergoes essential changes depending on the woman`s age or menstrual cycle periods, under the hormonal influence.

Read more on Can You Get Pregnant with One Fallopian Tube?

The lower part of the uterus, the narrowed region of the vagina, is known as the cervix. During pregnancy, the uterus`s size increases quite a lot – its height is of around 30 cm at the end of pregnancy.

So, what does it mean to have a tilted uterus? A retroverted uterus represents a uterus which is tilted posteriorly (tilted backwards towards the spine). The woman`s vagina isn`t positioned vertically inside the pelvis; it`s inclined towards the lower back. This represents the contrast of the “anteverted” uterus which most women have (this type of uterus is tilted forward toward the woman`s bladder.

While the retroverted uterus doesn`t cause problems in most cases, some women feel various signs, including pain during sexual intercourse.

Normal Position of the Uterus

The uterus is positioned next to the vagina, in a slightly inclined position towards the front, above the bladder. This specific position is known as “anteversion” and is considered the normal position of a woman`s uterus. The uterus is supported by ligaments which give it some sort of flexibility and at the very same time prevents it from descending into the vagina.

The uterus might change its position slightly during the menstrual cycle. Sometimes it might happen that the uterus`s position is also a bit oriented “backwards”. This particular position is known as “retroverted.” In this particular case, we talk about a retroverted uterus. Sometimes, the uterus`s position can also be inclined towards the right or left.

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:

  • Pregnancy – Another natural cause which can make as a normal uterus to become retroverted is pregnancy. After birth, the ligaments supporting the uterus lose their elasticity and tonicity, and the uterus instead of returning to the normal position (forward), it “falls” in the retroverted position (backwards).
  • Endometriosis – Endometriosis might cause the uterus to be “pulled” and “held” in the retroverted position by endometrial tissue outside the uterus. Due to this reason, the uterine mobility may suffer, being “forced” to stand in a position that isn`t normal.
  • Adhesions – An adherence represents a scar tissue which clutches 2 different anatomical surfaces (in general). Pelvic surgical interventions may lead to adhesions which may pull the uterus in a tilted position.
  • Fibroids – These are quite small (non-cancerous), but might make the uterus sensitive to tilt on the back.
  • Sexual Issues – In most cases, the ovaries and fallopian tubes are tipped backwards. This means that all these structures can be pushed out during a sexual contact, which is known as dysentery. If sexual contact is strong, the ligaments around the uterus might be injured or broken.

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.

Analyzes & Diagnosis

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

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.

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 What Causes Blocked Fallopian Tubes?

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.

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.

Read more on Pregnancy without Fallopian Tubes: Is this Even Possible?

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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