Retro-version of uterus

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1. RETROVERSION of UTERUS

2. Retroversion is the term used when the long axis of the corpus and cervix are in line and the whole organ turns backwards in relation to the long axis of the birth canal. Retroflexion signifies a bending backwards of the corpus on the cervix at the level of internal OS . The two conditions are usually present together and are loosely called RETROVERSION or RETRODISPLACEMENT. DEFINITION

3. Conventionally, three degree are described . First degree:- The fundus is vertical and pointing towards the sacral promontory. Second Degree:- The fundus lies in the sacral hollow but not below the internal OS. Third Degree:- The fundus lies below the level of the internal OS. DEGREES

4. DEVELOPMENTAL. ACQUIRED. DEVELOPMENTAL:- Due to development defect ,there is lack of tone of the uterine muscles. The infantile position is retained. This is often associated with short vagina with shallow anterior vaginal fornix. CAUSES

5. ACQUIRED:- PUERPERAL:- The stretched ligaments caused by child birth fail to keep the uterus in its normal position. PROLAPSE:- Retroversion is usually implicated in the pathophysiology of prolapse which is mechanically caused by traction following cystocele. TUMOR:- Fibroid, either in the anterior or posterior wall produces heaviness of the uterus and hence it falls behind. PELVIC ADHESIONS:- Adhesions either inflammatory , operative or due to pelvic endometriosis pull the uterus posterior.

6. INCIDENCE Retroversion is present in about 15-20 % of normal women.

7. Mobile Retroverted Uterus:- Symptoms:- Mobile retroverted uterus is quite common and almost always remains asymptomatic. Chronic premenstrual pelvic pain. Dyspareunia. Infertility. Signs:- Bimanual Examination Reveals :- The cervix is directed upwards and forwards. The body of the uterus is felt through the posterior fornix. Speculum examinataion reveals The cervix comes in view much easily and external os points forwards. Rectal examination :- It is help to confirm the diagnosis. CLINICAL PRESENTATION

8. The symptoms are related to the associated pelvic pathology, Menstrual abnormalitis . Congestive dysmenorrhea . Chronic pelvic pain. 2. FIXED RETROVERSION

9. To empty the bladder regularly. To increase the tone of the pelvic muscles by regular exercise. To encourage lying in prone position for half an hour once or twice daily between 2 and 4 weeks postpartum. PREVENTION

10. Pessary treatment . Surgical treatment . 1.pessary treatment= pessary is less commonly used in present day gynecologic practice. 1 ) for pessary test . 2) In subinvolution of uterus. 3) In pregnancy when spontaneous correction to antiversion fails by 12th week. usually, Hodge – smith pessary is used . The pessary acts by streching the uterosacral ligaments so as to be pull the cervix back wards . CORRECTIVE TREATMENT

11. 1. Surgical correction is indicated in case, where the pessary test is positive indicating that the symptoms are due to retroversion. 2. Fixed retroverted uterus producing symtoms like backache or dyspareunia. The principle of surgical correction is ventrosuspension of the uterus by plicating the round ligament of both the sides extraperitoneally to the under surface of the anterior rectus sheath, this will pull the uterus forwards and maintains it permanently in the same position. 2.Surgical treatment