Retroverted uterus and pregnancy – can it cause difficulties in getting pregnant?
A retroverted uterus is a term to describe a condition in which the uterus is tilted backwards towards sacrum. This condition may be seen in 20% of the women. In general, it does not lead to any health problems. A retroverted uterus can sometimes cause pain or is associated with an underlying disease. This abnormal position is of two types. In cases of mobile retroverted uterus, usually there are no symptoms. It is not associated with infertility and usually attains the normal anteverted position with advancing pregnancy when the enlarged uterus grows into the abdominal cavity. The other condition is called fixed retroverted position. In this position, the uterus is fixed to the structures behind due the formation of adhesions. This occurs in endometriosis and chronic pelvic inflammatory disease.
Effect of retroverted uterus on pregnancy
Infertility and Abortion – the retroverted gravid uterus has a contributory role in infertility and abortion. A clinical study showed that there is a higher risk of bleeding and abortion in cases with retroverted uterus in comparison to patients with normal anteverted uterus. This occurred mostly during 10 to 14 weeks of pregnancy. They concluded that the patients who had vaginal bleeding in early pregnancy had an equal risk of abortion irrespective of the position of the uterus. The risk of abortion is directly proportional to the duration of pregnancy after first trimester in patients with retroverted uterus.
Retention of urine – when the uterus increases in size and occupies the pelvis completely during 10 to 12 weeks of gestation, there is a risk of retention of urine. This occurs because the pressure of retroverted uterus stuck in the pelvis obstructs the urethra due to external pressure. The patient fails to pass urine and the bladder distends with urine.
Sacculation of uterus - in cases of persistent or fixed retroversion, the uterus balloons into the abdomen due to stretching of its wall. This forms a huge pouch which arises from its upper wall and is called sacculation (formation of a large sac). This may result in a risk of rupture of uterus which increases risk of fetal and maternal death rate.
A careful approach is required for the management of patients with a retroverted gravid uterus. During early pregnancy, these patients should be advised to sleep in prone position, especially around 14weeks of pregnancy with the hope of spontaneous correction of retroversion. At around this time the pregnant uterus outgrows the pelvis and extends upwards into the abdomen. These patients are also advised to pass urine frequently so as to empty their urinary bladder. A full bladder tends to push the uterus backwards and may prevent correction of its position from retroverted to anteverted. A regular bladder emptying and patient position will result in correction of position of the uterus in majority of the cases.
An intercourse is also to be avoided in this type of uterus. An ultrasound examination can confirm the correction of position before completion of 14 weeks of pregnancy. Bimanual manipulation of the uterus may be performed with the consent of the patient to correct its position but it may increase the risk of abortion, especially if any force is applied.
Retroverted uterus usually does not affect the pregnancy adversely. After the first trimester, the expanding uterus grows out of the pelvis and then the pregnancy proceeds normally. In some cases the uterus may get stuck in the pelvis due to adhesions and can complicate the pregnancy. A careful management is required in these patients by more frequent antenatal examinations and early admission for close monitoring.