Retroverted Gravid Uterus

Retroverted Gravid Uterus

The 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.

In the 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 14^th week. Incidence: 1- 30,000 pregnancies.

Causes

·              Congenital anomalies of the pelvis and uterus

·              History of pelvis adhesions,

·              Edomentrosis, Fibroids, Ovarian or pelvic tumour.

Signs and Symptoms

Due to 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 fullness.

·              Low abdominal or back pain.

·              Frequency of micturation ,dysuria and paradoxical incontinence

·              Compression of the bladder neck leads to urinary retention.

·              Urinary stasis may result in infections like pyelonephritis

·              Constipation with impacted feaces.

·              On examination, bladder is palpable abdominally the fetal heart rate may be difficult to auscultate if the bowel is full.

Management

·              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.