Retroversion and inversion of the uterus
Author: khurram akhtar
Retroversion of the uterus
The uterus normally lies at an angle to the vagina so that the fundus is directed forwards and the cervix points backwards into the posterior fornix -the position of anteversion. If the fundus is directed backwards with the cervix pointing into the anterior fornix, the uterus is said to be retroverted. If the anteverted uterus is bent forwards on itself, it is said tQ be anteflexed; similarly the retroverted uterus may be retroflexed. Retroversion is recognized on bimanual pelvic examination when the cervix is found to be directed forwards and, with the examining fingers in the posterior vaginal fornix, the body of the uterus can be felt. It is important to ascertain the precise position of the uterus before inserting an intrauterine contraceptive device or taking an endometrial biopsy, and if there is doubt a uterine sound can be passed.
In 20 per cent of normal women the uterus is retroverted. Although cases of retroversion are described as 'congenital' the retroversion in f occurs at the time of puberty. In the infant the uterus is straight upright, with the cervix and body of equal length. As the body of uterus enlarges at puberty it usually becomes anteverted and anteflex but it sometimes adopts the opposite position.
This form of retroversion is of little clinical significance. The ute mobile and can be pushed forwards into the position of anteversion pressure in the posterior fornix. If pregnancy occurs, as the uterus en! it nearly always rises up into the abdomen in the normal way at about 12th week, and after delivery it resume~ its retroverted position. If uterus is observed to be retroverted in early pregnancy, no attempt sho be made to correct the position.
In rare instances the fundus of the retroverted gravid uterus beco impacted under the sacral promontory, and the uterus is then said to incarcerated in the pelvic cavity. The cervix is directed forwards and sligh upwards, as shown in Fig. 11.1. Because the bladder base is attached to supravaginal cervix the urethra becomes stretched and elongated, retention of urine may occur at about the 14th week. The disten bladder should not be mistaken for the pregnant uterus if the direction