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, but there are uncommon situations you should be aware of.

For example, miscarriage can occur if you develop a rare complication of a retroverted uterus called an incarcerated uterus. While serious, the problem can usually be fixed if it is recognized promptly.

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 a retroverted uterus to be a normal variation. It occurs in approximately one in five women.

A tipped uterus should not cause problems and rarely requires treatment. However, some women with retroverted uteri experience pain during intercourse, especially in certain positions.

A retroverted uterus does not usually affect a woman's fertility or experience of labor and delivery.

Impact During Pregnancy

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

If your uterus is retroverted your doctor, midwife, or ultrasound technician may have a harder time locating the fetal heart tones with a fetal doppler device during the first trimester of pregnancy. As your uterus grows, the issue usually resolves.

Incarcerated Uterus

In rare cases, the growing uterus becomes trapped by the pelvic bones and can't move out of the pelvis. This is a condition known as an incarcerated uterus.

An incarcerated uterus can cause a second-trimester miscarriage. If the pregnancy continues into the third trimester, other pregnancy complications can occur including uterine rupture or preterm delivery. 

Intrauterine growth restriction of the fetus may also occur. If the uterus is not enlarging properly, it limits how much the fetus can grow. An incarcerated uterus can also cause complications for the mother, including blood clots, kidney dysfunction, or bladder problems. 

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

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

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

If your OB/GYN is worried about an incarcerated uterus, they 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 usually get your uterus back in the right place manually. Less commonly, a surgical procedure is needed. 

Other Factors and Causes

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

  • Endometriosis. Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside of the uterine cavity. The tissue is usually found on the outside of the uterus, the ovaries, the pelvic cavity, and the bladder.
  • Pelvic inflammatory disease (PID). PID is an infection caused by bacteria and is most often sexually transmitted. Bacteria can also be introduced into the pelvic organs during medical procedures, such as having an intrauterine device (IUD) inserted. However, this is much less common than sexually transmitted PID. 
  • Pelvic surgery. Previous pelvic or abdominal surgery, such as laparoscopy for endometriosis, can cause adhesions to grow in areas affected during the procedure. 

Having 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 developing an incarcerated uterus.

While there are some possible risk factors, there are also reports of women with no known risk factors developing an incarcerated uterus during pregnancy.

A Word From Verywell

If you have been told that you have a retroverted uterus and are concerned about the position of your uterus (regardless of whether you are pregnant or planning a pregnancy), talk with your doctor.

An OBGYN can explain the condition and reassure you that, in the vast majority of cases, the anatomical variation does not interfere with a normal pregnancy.

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Article Sources
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