= Solution
\b[Suspect <uterine retroversion> from examination and the clinical setting, while distinguishing an incidental position from symptomatic disease or an incarcerated pregnant uterus.] Pelvic pressure, backache, painful <menstruation>, pain with intercourse, difficulty voiding or rectal pressure can prompt assessment, but none proves that the uterine position is the cause.
In retroversion the <uterus> tilts backwards as a whole; <uterine retroflexion> instead describes bending between its body and <cervix>. The two can coexist. On an appropriate pelvic examination, the uterine body may be felt posteriorly while the <cervix> points more anteriorly. Mobility, tenderness, a pelvic mass and the possibility of <pregnancy> affect interpretation. Symptoms may come from associated <endometriosis>, adhesions or another pelvic disorder rather than the tilt itself.<Retroverted Uterus by Cleveland Clinic>[Anatomy, symptoms, associated conditions and diagnosis]{ref}
The especially important historical presentation is early or mid-<pregnancy> with increasing pelvic pressure and <urinary retention>. An enlarged backward-lying <uterus> can remain trapped beneath the pelvic brim, distorting the <cervix> and bladder outlet. Dribbling <urine> can represent overflow from retention, not adequate emptying. A distended <urinary bladder> and a posterior pelvic mass require careful assessment rather than treatment with a diuretic. A pre-1866 account of retroversion after conception emphasized retention as a principal presenting problem.<Retroversio uteri post conceptionem in the British Medical Journal (1860)>[17 November 1860, p. 889, diagnostic signs and retention of urine]{ref}
Historical treatment aimed first to empty an overdistended <urinary bladder> with a catheter, then to restore position where appropriate and prevent recurrence, sometimes with positional measures or a <vaginal pessary>. A fixed, painful or possibly pregnant mass made blind forceful manipulation particularly hazardous. Describing the aim of a period manoeuvre does not make repeated unassessed attempts at repositioning acceptable.
\b[Modern correction: an asymptomatic retroverted <uterus> commonly needs no treatment.] Symptoms call for investigation of their actual cause; retroversion alone does not establish infertility or explain every miscarriage. For selected symptomatic mobile cases, conservative support or a fitted <vaginal pessary> may be considered, while associated disease is managed on its merits.<Retroverted Uterus by Cleveland Clinic>[Management, fertility and distinction from rare uterine incarceration]{ref} Suspected incarceration in <pregnancy>, especially with <urinary retention>, needs urgent obstetric assessment. <Ultrasonography> can clarify the anatomy; <magnetic resonance imaging> may help when the relation of the <uterus>, <urinary bladder> and <cervix> remains uncertain. Drainage of the <urinary bladder> and any attempt at reduction are specialist decisions guided by gestation, anatomy and complications. Published evidence is largely case reports and series, so a single successful method is not a universal rule.<Incarcerated gravid uterus: a systematic review (2023)>[Presentation, diagnostic imaging and management; limitations of case-based evidence]{ref}
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