Uterine prolapse

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Uterine prolapse

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04/12/2023

Definition

The uterus gradually descends in the axis of the vagina taking the vaginal wall with it. It may present clinically at any level, but is usually classified as one of three degrees.


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Degrees of uterine prolapse

First degree:cervix still inside vagina

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Degrees of uterine prolapseSecond degree:the cervix appears outside the vulva.

The cervical lips may become congested and ulcerated


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Degrees of uterine prolapseThird degree:complete prolapse.In the picture the uterus is

retroflexed,and the outline of bladder can be seen.This is sometimes called complete procidentia.


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Causes

The stretching of muscle and fibrous

tissue

Increased intra-abdominal pressure


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In recent years,the incidence of prolapse is greatly reduced .The more liberal use of caesarean section and the elimination of labours are probably the two most important factors.


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Symptoms

• Something coming down• Backache• Increased frequency of micturition• A ‘bearing down’ sensation• Stress incontinence• Coital problems• Difficulty in voiding urine






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Treatment

Pessary treatment Indications

Patient prefers a pessary.

Pelvic surgery risks

Prolapse amenable to pessary

The patient is not fit for surgery

Patient wishes to delay operation






Surgery

Anterior colporrhaphy

(and repair of cystocele) Posterior colpoperineorrhaphy

(including repair of rectocele) Manchester repair Vaginal hysterectomy


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Uterine prolapse

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