What is the significance of uterine positioning in gynecology?

From the Guidelines

Uterine positioning plays a crucial role in maintaining maternal hemodynamics and fetal well-being, particularly during pregnancy and childbirth. The significance of uterine positioning is evident in its impact on various aspects of women's health, including:

• Reducing the risk of aortocaval compression, which can impede venous return and reduce stroke volume and cardiac output, as highlighted in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1
• Improving maternal hemodynamics, as demonstrated by the use of left-lateral tilt, which can improve blood pressure, cardiac output, and stroke volume, as well as fetal parameters of oxygenation, nonstress test, and fetal heart rate 1
• Preventing complications during pregnancy, such as preterm labor, placental abruption, and fetal growth restriction, which can be associated with abnormal uterine positions
• Facilitating successful outcomes in assisted reproductive technologies, such as in vitro fertilization (IVF), by ensuring proper uterine alignment for implantation

Key considerations for uterine positioning include:

• Manual left lateral uterine displacement to alleviate aortocaval compression, as recommended by the 2020 American Heart Association guidelines 1
• Left-lateral tilt to improve maternal hemodynamics and fetal well-being, particularly during surgery or cardiac arrest, as suggested by the 2010 American Heart Association guidelines 1
• Avoiding aortocaval compression by positioning pregnant women above 20 weeks gestation to avoid compromising cardiovascular function, as advised by the 2017 British Thoracic Society guideline for oxygen use in adults 1

From the Research

Uterine Positioning Significance

The significance of uterine positioning in gynecology is a topic of interest in various studies. Some key points to consider include:

• Uterine malformations, such as a T-shaped uterus, have been associated with poor reproductive performance 2
• The position of the uterus can affect fertility, with some studies suggesting that a retroverted uterus may be associated with subfertility 3
• Uterine position can be estimated through vaginal cervical position, but ultrasonographic examination is essential for a definitive determination of uterine anatomy 4

Impact on Fertility and Pregnancy Outcomes

Research suggests that:

• A retroverted uterus may be associated with a higher likelihood of requiring in vitro fertilization (IVF) 3
• However, uterine position does not appear to significantly impact pregnancy complications or vaginal delivery outcomes 3
• The relationship between maternal positioning and fetal positioning in utero is not well understood, with some studies finding no statistical relationship between the two 5

Diagnostic Methods

Various diagnostic methods are used to determine uterine position and anatomy, including:

• 3D-ultrasound, considered the gold standard in diagnosing uterine anomalies 2
• Transvaginal ultrasonography, used to record uterine anatomy 4
• Vaginal speculum examination, which can provide information about uterine anatomy through cervical position observation 4

Biomechanical Perspectives

The position of the uterus and the forces generated during childbirth can affect maternal, fetal, and neonatal outcomes 6

• Vertical birthing positions have been suggested to have many benefits, but more research is needed to understand the advantage of one position over another 6