الفهرس 
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Abstract
The uterine position is traditionally defined by 2 angles: the flexion angle between the uterine body and the cervix and the version angle between the cervix and the vagina. In an anteflexed uterus, the uterine fundus is angled toward the anterior abdominal wall. In contrast, in a retroflexed uterus, the fundus is angled toward the sacrum. The angle between the axis of the trunk and the axis of the cervix in the longitudinal plane indicates uterine flexion. If this angle is 179.9 ° or less, the uterus is anteflexed, and if it is more than 180 °, the uterus is in retroflexion. The angle between the axis of the cervix and the axis of the vagina in the longitudinal plane indicates uterine version. If that angle is 90° or less, the uterus is in antevertion, and if it is more than 90°, the uterus is in retroversion. Therefore, anteflexion and anteversion of the uterus considered a natural position uterus in pelvis.
Ultrasound provides the most accurate diagnostic method. It was determined that an accurate diagnosis of a retroverted uterus required: (a) the use of transvaginal ultrasound because of the superior resolution and the proximity of the probe to the area of interest and (b) a completely empty bladder.
The incidence of cesarean deliveries has increased substantially over the past 25 years worldwide. In addition, the number of gynecologic procedures involving the uterus has risen. For example, surgical evacuation for termination of pregnancy has increased 2-fold. Copper intrauterine device (IUD) and levonorgestrel-releasing IUD placement has increased such that 14% of women are using an IUD worldwide.
Some surgeons use uterine manipulators during operative or diagnostic laparoscopy in patients with a uterine pathology to facilitate manipulation, and the use of uterine manipulators has its complications as well, complications such as uterine perforation, uterine vascular injuries, bowel or bladder injuries and vaginal lacerations are associated with the use of uterine manipulator.
Uterine position is of interest, since some studies have found associations between uterine version/flexion and pain intensity in some gynecological conditions such as dysmenorrhea, dyspareunia, and chronic pelvic pain. Another hypothesis is that uterine retroversion may promote venous congestion disease, a condition responsible for various pain symptoms including dyspareunia and dysmenorrhea. Pelvic venous congestion is frequently associated with uterine retroversion.
The aim of this study was to assess whether cesarean delivery changes the natural position of the uterus by transvaginal ultrasound examination.
Inclusion criteria included non pregnant females and their age from 20-40 years old and excluded any case with any uterine surgery other than CD such as myomectomy, fibroid more than 3 cm, pelvic prolapse, endometriosis, pregnant women and history of pelvic inflammatory diseases. In the current study, examinations were performed on 216 patients. 72 of the patients had undergone CD. Those patients were compared with the 72 parous patients who had not undergone CD (32 case had one CD, 18 had 2 CD and 22 had 3 CD) and 72 patients who had never been delivered. Of these, 158 (73.1 %) uteri were anteverted, including 33 (15.2) that were also anteflexed. 23 (10.6 %) uteri were retroverted, including 12 (5.5%) that were also retroflexed. 11(5.09%) uteri were axial. 22(10.1%)
Summary
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uteri were anteverted retroflexed and 2(0.9%) were retroverted anteflexed. This higher number of anteverted retroflexed uteri in the CD group was statistically significant (p ≤ 0.001). The proportion of patients with myometrial thinning at the incision site is (65.3%) in our series, the scar seen and there was thinning in all cases of anteverted retroflexed position but there was no thinning in 13 cases and scar not seen in 12 cases of other positions. We found an increase in anteverted retroflexed uterine attitude and related it to thinned CD incisional scars. Our data confirm the association of myometrial thinning and retroflexion position. And also the uterus can be affected by the development of adhesions. After cesarean delivery, the uterus frequently assumes an anteverted retroflexed position because of adhesions. So this demonstrated the effect of CD on position of uterus.