Questions about Malposition of Uterus

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In modern time, surgery for the correction of uterine retroversion in the absence of evidence of endometriosis or other specific pathologic conditions has fallen into disrepute.

Mal-position of the Uterus

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Uterine Retroversion

During early pregnancy, uterine retroversion is a normal positional variant. Typically, first-trimester retroversion is intermittently present 10-20% of the time.

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Normal pelvic anatomy permits the fundus of the uterus to move relatively freely in the sagittal, vertical, oblique, and anteroposterior planes. In retroversion, the uterus is tipped posteriorly and may be fixed in this position by the presence of adhesions.

Pathophysiology

Clinical Presentation

women with a history of symptomatic incarceration should be evaluated frequently in the late first trimester and early second trimester to ensure that the uterus does not become fully incarcerated if it remains retroverted.

Diagnosis

The diagnosis of incarceration is established by performing a pelvic examination and pelvic sonography and by considering these data in combination with the characteristic clinical history.

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Manual uterine replacement: manipulation of the uterus into its usual anatomic position, with or without tocolysis and/or anesthesia

Treatment

Bladder decompression and patient positioning

The best initial treatment for symptomatic mid trimester incarceration of a normal uterus is a trial of bladder decompression combined with a program of patient positioning. Such management relieves most cases.

Postprocedural care

After any procedures to attempt uterine replacement, administration of Rh immunoglobulin is indicated in Rh-negative patients who are not isoimmunized.

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