Will Having a Tilted Uterus Increase Your Risk of Miscarriage?

One in five women has a tilted, or retroverted, uterus.

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Many women wonder whether having a retroverted or tilted uterus can be a factor in pregnancy loss. Typically, the answer is no.

That being said, miscarriage may occur in the rare but severe instance that a complication develops as a result of having a retroverted 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 tipped uterus, the uterus is rotated back towards the spine and rectum. This tipping is called a retroverted uterus or a tipped or tilted uterus. 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. That being said, some women who have retroverted uteri may experience pain during intercourse.

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 of pregnancy. In most cases, a retroverted uterus will assume the normal position at some point during pregnancy.

During the first trimester, if you have a tipped uterus, your doctor may have a hard time finding your uterus on an ultrasound. That being said, as your uterus grows, it will no longer be difficult to locate.

In rare cases, a tilted uterus does not correct during pregnancy and may become trapped in the pelvis, causing a condition known as incarcerated uterus. An incarcerated uterus may cause a second-trimester miscarriage or other pregnancy complications like uterine rupture, preterm delivery, or intrauterine growth restriction.

Maternal problems may also result like blood clots, kidney dysfunction, or bladder problems. 

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

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

  • difficulty or inability to urinate (this is called urinary retention)
  • incontinence
  • abdominal pain
  • constipation
  • discomfort in your rectal area

If your doctor is worried about an incarcerated uterus, she will perform a pelvic exam and an ultrasound, as well as a magnetic resonance imaging (MRI). As long as you are before 20 weeks gestations, doctors can perform manual reduction to get your uterus back in the right place. Less commonly, surgical reduction is needed. 

Other Factors Which 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 condition is caused by bacteria and is usually sexually transmitted. Bacteria can be introduced through medical procedures, like having an intrauterine device (IUD) inserted, although this is much less common than sexually transmitted PID. 
  • Pelvic surgery: Previous pelvic surgery, like a laparoscopy for endometriosis, can cause adhesions to grow in places that were manipulated during the procedure. Abdominal surgery too may increase a woman's chance of developing an incarcerated uterus. 

Ovarian cysts, multifetal pregnancies (for example, twin or triplets), uterine fibroids on the back part of the uterus, and congenital uterine malformations may also increase a woman's chance of developing an incarcerated uterus.

This all being said, there are reports of pregnant women developing an incarcerated uterus who had none of these conditions or factors. 

A Word From Verywell

If you have a retroverted uterus and have any worries or concern (regardless if you are pregnant or planning a pregnancy), please talk with your doctor, so you can be informed and at ease. 

Sources:

Callen PW. OB-GYN Ultrasound Online. Incarcerated Uterus.

Shnaekel KL, Wendel MP, Rabie NZ, Magann EF. Incarceration of the gravid uterus. Obstet Gynecol Surv. 2016 Oct;71(10):613-19.

University of Maryland Medical Center. (July 2014). Retroversion of the Uterus. 

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