‫أ‪.

‬د‪ /‬سهير محمود القصيرى‬

‫أستاذ ورئيس قسم العالج الطبيعى‬
‫لصحة المرأة‬
‫كلية العالج الطبيعى‬
‫جامعة القاهرة‬
Retroversion &
Retroflexion of
the uterus
(RVF)
 Version Flexion

It is the angle between longitudinal It is the angle between the

axis of the cervix and that of the longitudinal axis of the uterine body
vagina. and that of the cervix.

Flexion
Normally, the uterus is
anteverted, anteflexed.
Version
 Ante-version

• The longitudinal axis of the

cervix bent forward on the

longitudinal axis of the vagina by

90 ̊.
Factors maintaining
ante-version
 Ante-flexion

• The longitudinal axis of the

uterine body bent forward on the

longitudinal axis of the cervix by

170 ̊.
Factors maintaining
ante-flexion
 Retro-version Retro-flexion

• The uterus is directed backward

towards the sacrum at level of the

external os.
 Varieties of RVF

A) Congenital:
1) Retroversion of hypoplastic uterus
(underdevelopment).

In infancy, the uterus is smaller than the cervix, has

poor vascular supply and is retroverted. With the onset of
ovarian function, the uterus grows rapidly, the blood
supply increases and it is anteverted. 20% of women
anteversion doesn’t occur.
2) Retroversion of a normal uterus.
This type is common and give rise to no
symptoms. It is often discovered accidentally.
It requires no treatment, except in cases of
sterility (high position of external os).
B) Acquired:
1) Retroversion complicated by pelvic
pathological lesions (e.g. chronic salpingitis,
endometriosis or pelvic tumors (fibroids)).

The uterus may be pushed backwards by an anterior

wall fibroid or may be pulled backwards by
adhesions.
2) Puerperal retroversion:

It is usually associated with a bulky heavy sub-

involuted uterus and is caused by:
• Laxity of the uterine support.

• Increased bulk and weight of the body of the uterus.

• Lying in the dorsal position, gravity helps the retro-

displacement.

• Persistent distention of the bladder during puerperium.

 Vicious Circle of RVF

Puerperal
retroversion

Heavy bulky Uterine

uterus congestion

Sub-involution
 Degrees of RVF

1st degree:

The fundus is directed towards the promontory of the sacrum.

2nd degree:

The fundus is directed towards the sacral concavity.

3rd degree:

The fundus is directed towards the tip of the sacrum.

 Symptoms of RVF

a) Backache.
b) Congestive dysmenorrhea.
c) Menorrhagia.
d) Dyspareunia.
e) Leucorrhoea.
f) Sterility.
Methods of correction of
mobile RVF

Bimanual

Instrumental Postural
Bimanual correction
Postural correction
Instrumental correction
 Treatment of RVF

1. Prophylactic

3. Surgical 2. Palliative
 Prophylactic Treatment

1. Avoid crock lying or dorsal position, in which gravity helps the

retro-displacement of a heavy and bulky uterus.

2. Encourage relaxation on face & knee-chest position.

3. Evacuate the bladder every two hours.

4. Encourage the mother to lactate her baby.

Uterine
Lactation Oxytocin
involution
 Palliative Treatment

Hodge Smith Pessary

The upper end lies in the posterior fornix, while the lower end is in
contact with the anterior vaginal wall behind the symphysis pubis.
Pessaries are not used in cases of fixed RVF.

Indications of pessaries:

1. As a pessary test before operation of correction.

2. Early pregnancy with RVF (history of previous abortion with

no other cause can be found).

3. RVF during puerperium.

4. Patients refusing operation or with bad surgical risks.

 Surgical Treatment

Indications:
• In cases of mobile or fixed RVF with marked
symptoms.

P.T. role
• Pre and postoperative (same as C.S except arm
exercises).