The Potential Role of Uterine Retroversion in Pelvic Pain Symptoms and Caesarean Delivery

Yıl 2021, , 239 - 243, 31.12.2021

Meral Tuğba Acar Çimşir , Muhammet Serhat Yıldız

https://doi.org/10.30565/medalanya.883872

Öz

Aim: Uterin Retroversion is a common status in the women population and assumed to be related with pelvic pain symptoms. The aim of this study is to investigate whether uterine retroversion is associated with pelvic pain symptoms and is a reason for cesarean delivery.

Method: One hundred thirty-three premenopausal women admitted in a Tertiary Education and Research Hospital, Department of Gynecology unit for pregestational counseling were evaluated for pelvic pain symptoms with a self-administrated questionnaire. Uterine position was assessed by pelvic examination and transvaginal ultrasound. Sixty-one women had a retroverted uterus (group1), and seventy-two had an anteverted or intermediate uterus (group2). Dyspareunia, dysmenorrhea, weight, Body Mass Index (BMI), cyclic pain, ovulation pain, premenstrual pain and mode of delivery were compared between the Retroverted group and the Anteverted or intermediate group. After successful conception and pregnancy survey, mode of delivery was also compared.

Results: Dyspareunia, dysmenorrhea, weight, BMI, cyclic pain, ovulation pain, premenstrual pain, patients’ sexual activities restrictment due to dyspareunia, patients medical treatment requirement for dysmenorrhea, and mode of delivery was statistically significant between two groups. (p<0.05). However, PMS (premenstrual syndrome), height, gravid and parity were similar (p>0.05).

Conclusion: Uterine retroversion is associated with a higher prevalence of cesarean rate, pelvic pain and visual analogue scale for dyspareunia and dysmenorrhea in a population of unselected women.

Anahtar Kelimeler

Cesarean, Dysmenorrhea, Dyspareunia, Uterine retroversion

Pelvik Ağrı Semptomlarında ve Sezaryen Doğumunda Uterin Retroversiyonunun Potansiyel Rolü

Öz

Amaç: Uterin Retroversiyonu kadın popülasyonunda yaygın bir durumdur ve pelvik ağrı semptomları ile ilişkili olduğu varsayılmaktadır. Bu çalışmanın amacı, uterus retroversiyonunun pelvik ağrı semptomları ile ilişkili olup olmadığını ve sezaryen doğum nedeni olup olmadığını araştırmaktır.

Yöntem: Üçüncü Basamak Eğitim ve Araştırma Hastanesi Kadın Hastalıkları Kliniği kliniğine pregestasyonel danışmanlık için başvuran 103 premenopozal kadın, kendi kendine uygulanan anket formu ile pelvik ağrı semptomları açısından değerlendirildi. Uterin pozisyonu pelvik muayene ve transvajinal ultrason ile değerlendirildi. Altmış bir kadında uterusu retroverted (grup 1) ve yetmiş ikisinde ise ileri dönük veya orta uterus (grup 2) vardı. Retroverted grup ile Anteverted veya intermediate grup arasında disparoni, dismenore, ağırlık, Vücut Kitle İndeksi (BMI), döngüsel ağrı, yumurtlama ağrısı, adet öncesi ağrı ve doğum şekli karşılaştırıldı. Başarılı bir gebelik ve gebelik araştırmasından sonra, doğum şekli de karşılaştırıldı.

Bulgular: Disparoni, dismenore, kilo, VKİ, döngüsel ağrı, yumurtlama ağrısı, premenstrüel ağrı, disparoni nedeniyle hastaların cinsel aktivitelerinin kısıtlanması, dismenore için hastaların medikal tedavi gereksinimi ve doğum şekli iki grup arasında istatistiksel olarak anlamlıydı. (p <0.05). Bununla birlikte, PMS (adet öncesi sendrom), boy, ağırlık ve parite benzerdi (p> 0.05).

Sonuç: Uterin retroversiyonu, seçilmemiş kadınlardan oluşan bir popülasyonda daha yüksek sezaryen oranı prevalansı, pelvik ağrı ve disparoni ve dismenore için görsel analog skala ile ilişkilidir.

Anahtar Kelimeler

Sezaryen oranı, Dismenore, Disparoni, Uterin retroversiyon

Kaynakça

• 1. Cagnacci A, Grandi G, Cannoletta M, Xholli A, Piacenti I, Volpe A. Intensity of menstrual pain and estimated angle of uterine flexion. Acta Obstet Gynecol Scand. 2014;93(1):58-63. doi: 10.1111/aogs.12266. 2. Fauconnier A, Dubuisson JB, Foulot H, Deyrolles C, Sarrot F, Laveyssière MN, et al. Mobile uterine retroversion is associated with dyspareunia and dysmenorrhea in an unselected population of women. Eur J Obstet Gynecol Reprod Biol. 2006;127(2):252-6. doi:10.1016/j.ejogrb.2005.11.026.
• 3. Ott J, Nouri K, Demmel M, Zafraani S, Greilberger U, Huber JC, et al. Fourteen-year experience with laparoscopic ventrosuspension in patients with retroverted and retroflected uterus and pelvic pain syndromes. J Minim Invasive Gynecol. 2010;17(6):749-53. doi:10.1016/j.jmig.2010.07.015.
• 4. Atthill L. On the Relation of Anteflexion of the Uterus to Dysmenorrhoea. Br Med J. 1881;2(1095):1010-1. doi: 10.1136/bmj.2.1095.1010-a.
• 5. Moawad NS. Laparoscopic Uterine Ventrosuspension. J Minim Invasive Gynecol. 2018. doi:10.1016/j.jmig.2018.09.633.
• 6. Haylen BT, McNally G, Ramsay P, Birrell W, Logan V. A standardised ultrasonic diagnosis and an accurate prevalence for the retroverted uterus in general gynaecology patients. Aust N Z J Obstet Gynaecol. 2007;47(4):326-8. doi: 10.1111/j.1479-828X.2007.00745.x.
• 7. Freimanis MG, Jones AF. Transvaginal ultrasonography. Radiol Clin North Am. 1992;30(5):955-76. PMID: 1518939
• 8. Gottschalk EM, Siedentopf JP, Schoenborn I, Gartenschlaeger S, Dudenhausen JW, Henrich W. Prenatal sonographic and MRI findings in a pregnancy complicated by uterine sacculation: case report and review of the literature. Ultrasound Obstet Gynecol. 2008;32(4):582-6. doi: 10.1002/uog.6121.
• 9. Takami M, Hasegawa Y, Seki K, Hirahara F, Aoki S. Spontaneous reduction of an incarcerated gravid uterus in the third trimester. Clin Case Rep. 2016;4(6):605-10. doi: 10.1002/ccr3.577.
• 10. Singh MN, Payappagoudar J, Lo J, Prashar S. Incarcerated retroverted uterus in the third trimester complicated by postpartum pulmonary embolism. Obstet Gynecol. 2007;109(2 Pt2):498-501. doi: 10.1097/01.AOG.0000218695.71256.cf.
• 11. Barton-Smith P, Kent A. Asymptomatic incarcerated retroverted uterus with anterior sacculation at term. Int J Gynaecol Obstet. 2007;96(2):128. doi: 10.1016/j.ijgo.2006.09.010.
• 12. Chauleur C, Vulliez L, Seffert P. Acute urine retention in early pregnancy resulting from fibroid incarceration: proposition for management. Fertil Steril. 2008;90(4):1198.e7-10. doi: 10.1016/j.fertnstert.2007.10.008. 13. Charova J, Yunus D, Sarkar PK. Incarcerated retroverted gravid uterus presenting as placenta praevia. J Obstet Gynaecol. 2008;28(5):537-9. doi: 10.1080/14756360802236682.
• 14. van der Tuuk K, Krenning RA, Krenning G, Monincx WM. Recurrent incarceration of the retroverted gravid uterus at term - two times transvaginal caesarean section: a case report. J Med Case Rep. 2009;3:103. doi: 10.1186/1752-1947-3-103.
• 15. CME Review Article. Pediatr Emerg Care. 2017;33(12):792-3. doi: 10.1097/01.pec.0000526609.89886.37.
• 16. Uma R, Oláh KS. Transvaginal caesarean hysterectomy: an unusual complication of a fibroid gravid uterus. BJOG. 2002;109(10):1192-4. PMID: 12387479
• 17. Haylen BT. The retroverted uterus: ignored to date but core to prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(6):555-8. doi: 10.1007/s00192-005-0051-0.
• 18. Jamieson, Denise J.; Steege, John F. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol, 1996,87(1):55-8. doi:10.1016/0029-7844(95)00360-6
• 19. Wang L, Wang J, Huang L. Incarceration of the retroverted uterus in the early second trimester performed by hysterotomy delivery. Arch Gynecol Obstet. 2012;286(1):267-9. doi:10.1007/s00404-012-2223-8
• 20. Dierickx I, Meylaerts LJ, Van Holsbeke CD, de Jonge ET, Martens IF, Mesens T, et al. Incarceration of the gravid uterus: diagnosis and preoperative evaluation by magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol. 2014;179:191-7. doi: 10.1016/j.ejogrb.2014.05.037.
• 21. Carter JE. Surgical treatment for chronic pelvic pain. JSLS. 1998;2(2):129-39. PMID: 9876726.
• 22. Sanders RC, Parsons AK. Anteverted retroflexed uterus: A common consequence of cesarean delivery. AJR Am J Roentgenol. 2014;203(1):W117-24. doi:10.2214/AJR.12.10403
• 23. Balasch J, Creus M, Fábregues F, Carmona F, Ordi J, Martinez-Román S, et al. Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study. Hum Reprod. 1996;11(2):387-91. doi: 10.1093/humrep/11.2.387.
• 24. Matorras R, Rodríguez F, Pijoan JI, Soto E, Pérez C, Ramón O et al. Are there any clinical signs and symptoms that are related to endometriosis in infertile women? Am J Obstet Gynecol. 1996;174(2):620-3. doi: 10.1016/s0002-9378(96)70438-6.
• 25. Ahmet A. [Systematic Reviews and Meta-Analyses]. Acta Med. Alanya 2018;2(2):62-63. DOI: 10.30565/medalanya.439541