Cesarean delivery changes the natural position of the uterus on transvaginal ultrasonography

Andrea Kaelin Agten, Anne Honart, Ana Monteagudo, Spencer McClelland, Basmy Basher, Ilan E. Timor-Tritsch

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Objectives—To assess whether cesarean delivery changes the natural position of the uterus. Methods—In this retrospective Institutional Review Board-approved cohort study, we conducted a search of our university gynecologic ultrasonography (US) database. Patients with transvaginal US images before and after either vaginal or cesarean delivery between 2012 and 2015 were included. Women with prior cesarean delivery were excluded. Two readers independently measured antepartum and postpartum flexion angles between the longitudinal axis of the uterine body and the cervix. We calculated intraclass correlation coefficients to measure inter-reader agreement. Antepartum and postpartum uterine flexion angles were compared between patients with vaginal and cesarean delivery. Results—We included 173 patients (107 vaginal and 66 cesarean delivery). The mean interval between scans ± SD was 18 ± 10 months. Inter-reader agreement for flexion angles was almost perfect (intraclass correlation coefficients: antepartum, 0.939; postpartum, 0.969; both P<.001). There was no difference in mean antepartum flexion angles for cesarean delivery (154.8° ± 45.7°) versus vaginal delivery (145.8° ± 43.7°; P =.216).Mean postpartum flexion angles were higher after cesarean delivery (180.4° ± 51.2°) versus vaginal delivery (152.8° ± 47.7°; P =.001. Differences in antepartum and postpartum flexion angles between cesarean and vaginal delivery were statistically significant (25.6° versus 7.0°; P=.027). Conclusions—Cesarean delivery can change the uterine flexion angle to a more retroflexed position. Therefore, all women with a history of cesarean delivery should undergo a transvaginal US examination before any gynecologic surgery or intrauterine device placement to reduce the possibility of surgical complications.

Original languageEnglish
Pages (from-to)1179-1183
Number of pages5
JournalJournal of Ultrasound in Medicine
Issue number5
StatePublished - May 2018
Externally publishedYes


  • Cesarean delivery
  • Flexion
  • Gynecology
  • Uterus
  • Version


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