How to Determine the Normal Values for Anteverted and Retroverted Uterus

The position of a woman’s uterus can be directly visualized using pelvic color Doppler ultrasound or transvaginal color Doppler ultrasound, or assessed manually via gynecological bimanual or trimanual examination by palpating the abdomen.

Within the pelvis, the uterus may be positioned as anteverted (anterior), mid-positioned (mid-uterine), or retroverted (posterior). Under normal circumstances, the uterus is anteverted and anteflexed. “Anteversion” refers to the entire uterine body tilting forward; “anteflexion” denotes an angle less than 90 degrees between the longitudinal axis of the uterine body and that of the cervix and vagina.

When the uterine body tilts posteriorly toward the rectum, it is termed a retroverted uterus. Retroversion includes two subtypes: simple retroversion and retroversion with retroflexion. In simple retroversion, the longitudinal axis of the uterus remains unchanged while the entire uterus tilts backward. In retroversion with retroflexion, the uterus tilts backward and forms an acute angle at the junction between the uterine body and cervix. The former is more common, whereas the latter is relatively rare. Common causes include ligamentous laxity and injury to the pelvic floor diaphragm and the base of the broad ligament following multiple vaginal deliveries.

Generally speaking, an anteverted uterus is associated with a higher risk of placenta previa, but as a normal anatomical position, it confers better fertility potential compared to a retroverted uterus.