North American Registry of Midwives (NARM) Practice Exam

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Which of the following indicates a retro-flexed uterus during a bimanual exam?

  1. Uterus is straight and central

  2. Uterus bends forward at the isthmus

  3. Uterus bends backward at the isthmus

  4. Uterus is tilted to one side

The correct answer is: Uterus bends backward at the isthmus

A retro-flexed uterus is characterized by its positioning where the uterus bends backward at the isthmus. This anatomical positioning can be identified during a bimanual exam when the healthcare provider palpates the uterus and observes that it is not positioned in its typical forward-leaning posture. Instead, the retro-flexed uterus has an angle that points toward the rectum, which is often described as flexing backwards. The context of midwifery involves understanding different uterine positions, as they can impact both normal anatomy and potential implications for pregnancy and childbirth. The other described positions—such as a straight and central uterus, a uterus that bends forward, or a uterus that is tilted to one side—do not represent the characteristic backward angling of a retro-flexed uterus. Recognizing the nuances of uterine positions allows midwives to better assess and manage reproductive health.

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