Background: Retroversion of the uterus that occurs in about 15% of pregnancies together with weak pelvic floor musculature and increased intrabdominal pressure caused by pregnancy probably predisposed to this rare case.

Case report: A 35-year-old multiparous woman presented at 15 weeks gestation with large painful mass prolapsed outside the anus appeared suddenly after straining during defecation. Abdominal examination revealed no palpable gravid uterus. Ultrasound evaluation revealed gravid uterus inside the mass with single living fetus, biometry 14.3 weeks. Under general anesthesia reposition  of the uterus was done by continuous pull down on the cervical lips by ring forceps through the introitus with pushing the prolapsed mass through the anus. A rectal pack was inserted and intravenous tocolysis was given for 24 hours. Unfortunately, she was presented by inevitable miscarriage one week later.

Conclusion: Retroverted uterus can be herniated through the anus in multiparous women with lax pelvic floor muscles, so diagnosis of retroverted uterus is mandatory early in pregnancy and trials of conservative anteversion should be implemented manual reduction under general anesthesia with continuous downward traction on the cervix through the vagina is the optimum line of management of such cases. The probability of continuation of pregnancy in such cases is poor after the aggressive uterine manipulations used in reduction.