- First Degree: Fundus of the uterus is directed to the sacral promontory.
- Second Degree: Fundus lies in the hollow of the sacrum.
- Third Degree: Fundus lies below the level of the internal os in the pouch of Douglas. Clinically, the last two degrees are generally recognized as retroversion.
Incidence: About 10-20 per cent nulliparous women show retroversion while about 25 percent women have retroversion after first confinement. Causes:
- Developmental or congenital Defect.
- Acquired Defect:
- a) Puerperal: This is the commonest form.
- b) Uterine Prolapse
- c) Adnexal Disease
- d) Pressure by Tumor
Clinical Types: They may be:
- Mobile Retroversion
- Fixed Retroversion
- Complicated with tubo-ovarian mass
- Backache during premenstrual period.
- Dysmenorrhoea, menorrhagia like menstrual disorders.
Signs: Bimanual Examination reveals the condition as follows:
- Cervix is directed downwards and forwards towards the symphysis pubis.
- Body of the uterus cannot be felt through the anterior vaginal fornix, but can be felt through the posterior fornix.
- Mobility or fixity of the uterus should be determined by pushing up the uterus with fingers in the posterior fornix.
- Other associated pelvic0 lesions should be always searched for. Prolapsed ovary, if present should be detected.
Rectal examination can better confirm the bimanual vaginal examination findings. Diagnosis: Symptoms are less suggestive. Bimanual examination of vagina and rectum is necessary. In cases of doubt, examination should be best done under anaesthesia. Mobile retroversion may be mistaken by less experienced practitioner as a fixed one. Differential Diagnosis: The following conditions may be mistaken for retroverted uterus:
- Scybalous mass in the rectum- it pits by pressure with the fingers.
- Fibroid in the posterior wall of the uterus- the latter can be felt in position.
- Small ovarian tumor in the pouch of Douglas- uterus is felt in its normal position.
Old pelvic haematocele: More diffuse tender swelling; characteristic partly solid and partly soft feel; normal position of the cervix; the body of the uterus may be felt lying in front of the mass.