Prolaps of the Uterus

Prolaps of the Uterus

A descent of the uterus and always it is with parts of upper vagina with it.

Three degrees are recognonized.

·        First degree prolapse diagnosed when there is slight descent of the uterus but the cervix remains with in the vagina.

·        Second degree prolapse indicates that the cervix projects beyond the vulva when the patient strains. Third degree prolapse or complete procidential, the inside uterus has prolapsed out side the vulva and most it not all of the vagina is averted.

-                  Imperfect development of the supportive tissue

-                  stretching of the supportive tissues at child birth

-                  Atrophy of the supporting tissue 

Sign and Symptoms

·        A feeling of something falling out

·        Dragging pains in the pelvis

·        Some protrusion at the vulva

·        Difficulty or discomfort in micturation or defecation

Diagnosis

·        Types and degree of prolapse can be determined by

-                  Observing the vulva when the patient is straining or coughing

-                  Vaginal examination

·        The extent of the prolapse is often revealed more easily if the patient is put in the left lateral position and a sims’ vaginal speculum inserted and cervical and anterior vaginal wall descent can be more readily appreciated.

·        Prolapse must be differentiated from

-                  Hypertrophy of the cervix with no damage to the uterine supports

-                  Tumors or cysts of the vagina

-                  Tumors or cysts of the uterus, which project through the cervix

-                  Inversion of the uterus

Management

Preventive - Avoidance of pushing by the patient before full dilatation of the cervix

·        Avoidance prolongation of the second stage of labour

·        Avoidance of fundal pushing in an attempt to expel the placenta

·        Careful repair, in accurate layers, of all vaginal wall and perineal tears and incisions

·        Early ambulation and pelvic floor exercises in the puerperium

·        The treatment of an established symptomatic prolaspe is surgical

·        If no symptoms are present and there is no chronic urinary infection no treatment is required. The patient is reassessed at intervals.

·        The age and marital status of the patient does not alter the principle

In case of complete prolapse or procedentia the patient should be

·        Admitted to hospital prior to surgery to reduce the prolapse.

·        The vagina being packed with guaze impregnated with oestrodial cream to reduce the prolapse and permit ulcers healing and to subside cervical oedema.

·        The operation requires many excisions of the redundant vaginal tissues and repair other damaged tissue (anterior corporrhaphy or posterior corporrhaphy).

·        If utero vaginal prolaspe is present, amputation of the cervix and shortening of the transverse ligament which are streched to the front of the cervical stump (the Manchester operation) or vaginal hysterectomy is performed.