Retroverted Gravid Uterus
normal position of the uterus is anteverted and anteflexion i.e. leans forward
and bends forward on itself but in the case of retroverted gravid uterus, it
means the long axis of the uterus is directed backwards during pregnancy.
first trimester, retroversion of the uterus is said to occur in 11% of all pregnancies
and this is associated with slightly increased risk of early pregnancy bleeding
and abortion which may be due to compression of the uterine vessels decreasing
blood flow to the deciduas. But as pregnancy progresses most cases correct
spontaneously causing no further problems, but in some cases, the uterus
becomes incarcerated i.e. it fails to rise out of the pelvic cavity by the 14th
week. Incidence: 1- 30,000 pregnancies.
Congenital anomalies of the pelvis and uterus
History of pelvis adhesions,
Edomentrosis, Fibroids, Ovarian or pelvic tumour.
the confinement of the growing uterus within the pelvis, beneath the sacral
promontory, causing pressure leading to the following:
Abdominal discomfort and a feeling of pelvic
Low abdominal or back pain.
Frequency of micturation ,dysuria and paradoxical
Compression of the bladder neck leads to urinary
Urinary stasis may result in infections like
Constipation with impacted feaces.
On examination, bladder is palpable abdominally the
fetal heart rate may be difficult to auscultate if the bowel is full.
Catheterization is done to relieve the retention of
urine. An in-dwelling catheter is used to keep the bladder empty, enabling the
uterus to rise out of the pelvis.
Later an attempt is made to encourage the uterus to
assume an anteverted position, this may be achieved by putting the patient in
an exaggerated Sim’s lateral position or asking her to be in a semi-prone
position, if all these do not bring about spontaneous correction,
The doctor may attempt to correct the position of
the uterus with the patient placed in the knee-chest position (genupectoral
position) usually under general anaesthesia manually
Using Hodge pessary for 6-8 weeks.