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Clinical Obstetrics

Poster Session 4

(1140) Retroverted Uterus in the First Trimester and Associated Pregnancy Outcomes

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: To determine if retroverted (RV) uterus diagnosed at the time of nuchal translucency (NT) ultrasound is associated with second trimester pregnancy loss and other adverse pregnancy outcomes.

Study Design: This is a retrospective cohort study of patients with RV uterus documented on NT ultrasound at a single institution from 10/2019 to 03/2023. Subjects were identified using a query for “retroverted” uterus within the obstetric ultrasound imaging program. Two subjects with anteverted (AV) uterus were selected for every RV case and used as a comparison group. Patients with multiple gestation, Mullerian anomalies, fetal aneuploidy, or those who delivered at an outside institution were excluded. Maternal demographics, obstetrical, and neonatal outcomes were obtained by chart review. Chi-square test or Fisher’s exact test were used for categorical variables, and t-test or Mann-Whitney test were used for continuous variables, with p value < 0.05 denoting significance. Multivariable logistic regression was used to adjust for possible confounding variables.

Results: There were 249 subjects included: 83 in the RV group and 166 in the AV group. Most RV subjects (98%) had resolution of retroversion by the second trimester. Uterine incarceration requiring intervention occurred in three subjects. Significantly more RV subjects conceived by in vitro fertilization (IVF), 11% vs 3% (p=0.02). There was no difference in second trimester pregnancy loss between groups, 0% vs 1.2% (p=0.55). After adjusting for IVF, RV subjects were four times more likely to have first trimester vaginal bleeding (OR=4.1, p=0.001). There were no other differences in adverse outcomes, including first trimester pregnancy loss.

Conclusion: Persistent RV uterus in the first trimester is associated with increased risk of first trimester vaginal bleeding. However, rates of first and second trimester pregnancy loss were similar between groups, providing valuable information for patient counseling. Significantly more RV subjects conceived by IVF, highlighting the need for further study in this patient population.