Tilted Uterus and the Risk of Miscarriage

One in Five Women Has a Tilted, or Retroverted, Uterus

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Many women wonder whether having a retroverted uterus (also called a tipped or tilted uterus) can be a factor in miscarriage or pregnancy loss. Typically, the answer is no.

That being said, miscarriage may occur if you develop a rare but severe complication of a retroverted uterus, known as an incarcerated uterus. But, even in this uncommon situation, if recognized promptly, it can usually be fixed.

What Is a Retroverted Uterus?

Usually, the uterus sits horizontally over the bladder. In the case of a tilted uterus, the uterus is rotated back towards the spine and rectum. Generally, doctors consider this a normal variation, and it occurs in approximately one in five women.

A tipped uterus should cause no problems and rarely requires treatment. Some women who have retroverted uteri, however, may experience pain during intercourse, especially in certain positions. A retroverted uterus does not usually have any effect on fertility or a normal labor experience.

What Happens to a Retroverted Uterus During Pregnancy?

During the first trimester, you may experience some back pain or difficulty urinating from a retroverted uterus. However, these can also be symptoms in any pregnancy. In most cases, a retroverted uterus will assume the normal position at some point during pregnancy.

Your doctor may have a hard time locating a tilted uterus on an ultrasound during the first trimester of pregnancy. As your uterus grows, however, identifying it won't be a problem.

In rare cases, a tilted uterus does not correct during pregnancy and may become trapped in the pelvis, causing a condition known as an incarcerated uterus. An incarcerated uterus may cause a second-trimester miscarriage or other pregnancy complications including uterine rupture, preterm delivery, or intrauterine growth restriction, which can restrict normal growth of the fetus and cause the baby to be underweight at birth. Maternal problems may also result, including blood clots, kidney dysfunction, or bladder problems. 

Having an incarcerated uterus is extremely uncommon, though, occurring in only about 1 in 3,000 pregnancies, and is not a factor in unexplained first-trimester miscarriages.

Symptoms of an incarcerated uterus typically develop at around 14 to 16 weeks gestation and may include:

  • Difficulty or inability to urinate (this is called urinary retention)
  • Urinary incontinence
  • Abdominal pain
  • Constipation
  • Discomfort in your rectal area

If your OB/GYN is worried about an incarcerated uterus, she will perform a pelvic exam and an ultrasound, as well as magnetic resonance imaging (MRI). As long as you are less than 20 weeks into your pregnancy, doctors can get your uterus back in the right place manually. Less commonly, a surgical procedure is needed. 

Other Factors That May Cause a Retroverted Uterus

Sometimes a uterus is tipped because of scar tissue or pelvic adhesions. These adhesions may be caused by:

  • Endometriosis: A condition where tissue similar to the lining of the uterus grows outside of the uterine cavity. This tissue is usually found on the outside of the uterus, the ovaries, the pelvic cavity, and the bladder.
  • Pelvic inflammatory disease (PID): This is caused by bacteria and is usually sexually transmitted. Bacteria can be introduced through medical procedures, such having an intrauterine device (IUD) inserted, although this is much less common than sexually transmitted PID. 
  • Pelvic surgery: Previous pelvic surgery, such as a laparoscopy for endometriosis, can cause adhesions to grow in places that were affected during the procedure. 

Ovarian cysts, multiple pregnancies (for example, twins or triplets), uterine fibroids on the back part of the uterus, and congenital uterine malformations may also increase the risk of an incarcerated uterus. There are also reports of pregnant women developing an incarcerated uterus who had none of these conditions or factors. 

A Word From Verywell

If you have been told you have a retroverted uterus and have any worries or concerns (regardless if you are pregnant or planning a pregnancy), please talk with your doctor, who can explain the details and reassure you that, in the vast majority of cases, this anatomical variation does not interfere with a normal pregnancy.

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