In the pelvic cavity, the uterus usually tilts forward toward your lower stomach. But in some cases, it tips back toward the spine. About 1 in 5 women have this anatomical variation.
A tilted (also known as tipped or retroverted) uterus may affect your first pregnancy ultrasound and make it difficult to detect the heartbeat early on. However, its effects appear to be limited to the first trimester. It turns out that your spine wasn't designed to stretch as much as your stomach, so the uterus normally returns to its expected position as the pregnancy progresses and your baby grows.
What Is an Ultrasound?
A standard ultrasound is a procedure that uses sound waves to create a two-dimensional picture of a pregnant woman's pelvic cavity and abdomen. A sonographer applies gel to the woman's abdomen during the examination, which serves as a conductor that delivers sound waves into the area. The waves create an image of the fetus as the waves bounce off of tissue and bones.
An ultrasound is a handy tool that can help detect developmental problems in the fetus and possible pregnancy complications. A pregnant person may have the procedure during any time of their pregnancy, but they are normally performed around 10 weeks and 20 weeks. If your baby has any complications, or if you're expecting multiples, your doctor may want to do some extras. Considering the size of the fetus in early pregnancy, it may be possible that a titled uterus makes it more difficult for an ultrasound to detect the developing baby.
Tilted Uterus and Ultrasounds
During the first trimester, a doctor will probably suggest an ultrasound to confirm a pregnancy or to confirm problems like an ectopic pregnancy. The first stage of pregnancy is extremely important for the baby's development and the heartbeat is a sound that many people eagerly anticipate during this type of procedure.
A tilted uterus during an abdominal ultrasound may prevent the test from detecting a heartbeat, which can be very distressing for the mother. However, if an ultrasound doesn't detect a heartbeat early in the pregnancy, it doesn't mean that there is a problem. A transvaginal ultrasound, in which an ultrasound probe is placed in the vagina to visualize the baby, can get around this problem.
A tipped uterus, however, should not prevent a sonographer from seeing the developing baby through abdominal ultrasound, especially as the pregnancy progresses. If you have an ultrasound at nine weeks, for example, the sonographer should be able to see the baby. If the test fails to detect a gestational sac, a doctor may order a blood test that measures hormone levels to show if the pregnancy is far enough along for a gestational sac to be present.
Should You Worry About a Tilted Uterus Before or During Pregnancy?
According to the American Pregnancy Association, a tipped uterus is not usually a cause of fertility problems. Physicians may, however, look at this structural difference after other possible causes of infertility have been examined and ruled out. During pregnancy, a tipped uterus returns to its forward-leaning position at about 11 weeks and the condition shouldn't affect the pregnancy, labor or childbirth.
Women trying to conceive may want to have an examination to detect a tilted uterus. An ultrasound isn't necessary for a diagnosis since a doctor can easily detect the condition during a routine pelvic exam. A physician may want to reposition the womb before conception.
Some people are born with a tilted uterus, and it is even considered a normal variation of organ placement. However, outside influences can also cause the shift.
If you have a tilted uterus, you probably won't feel any symptoms at all. Rarely, people report:
- Difficulty inserting tampons
- Incarceration, which occurs when the uterus gets trapped in the pelvis and baby can't grow. (very rare)
- More painful menstruation
- Pain with sex
- Pelvic pain
- Uterine prolapse
There is some disagreement in the literature about whether or not a tipped uterus affects fertility, but more on that later.
Most of the time, no treatment at all is needed for a tilted uterus. If you are experiencing pain or other symptoms, you can speak with your doctor about the possibility of treating symptoms. Your doctor may manually adjust the uterus while pregnant, to be sure your baby has plenty of space to grow. But if you have it adjusted while not pregnant, it will likely just tip right back where it wants to be. Your uterus is stubborn, just like your kids.
Overall, don't worry about a tilted uterus. If your ultrasound technician has trouble finding a heartbeat at your first ultrasound, feel free to bring up this possibility, especially if you know you have this anatomical difference.