Prolapse Flashcards
The Three Levels of Support for the Uterus
Level 1: The cervix and upper 1/3 of vagina
Transverse cervical (cardinal) ligament Cervix --> pelvic side wall
Ueterosacral ligament
Cervix –> sacrum
Level 3: Mid portion of vagina Endofascial condensation (endopelvic fascia)
Lateral support to the pelvic side walls
Level 3: lower 1/3 of vagina
Levator ani muscles
Form floor of pelvis
The 5 Types of Prolapse
Urethrocoele: prolapse of lower anterior vagina wall involving urethra only
Cystocoele: Prolapse of upper anterior vaginal wall, involving the bladder
(associated prolapse of urethra = cystourethrocoele)
Apical: Prolapse of uterus, cervix and upper vagina
If uterus has been removed, the vault itself can prolapse
Enterocoele: Prolapse of upper posterior wall of vagina, pouch normally contains loops of bowel
Rectocoele: Prolapse of lower posterior wall of vagina, involves anterior wall of rectum
Grading of Prolapse
ICS POP
Condition of examination must be specified
0: No descent of pelvic organs during straining
1: Leading surface does not extend below 1cm above hymenal ring
2: Leading surface extends from 1cm above to below 1cm above hymenal ring
3: Prolapse extends >1cm below hymenal ring but without vaginal eversion
4: Vagina completely everted (complete)
Prolapse
half of parous women half prolapse
Aetiology
Vaginal delivery –> denervation of pelvic floor
Risk increased with large infants, prolonged second stage and instrumental delivery
Congenital: Ehlers-Danlos syndrome (altered collagen metabolism)
Menopause: Deterioration of collagenous connective tissue after oestrogen withdrawal
Chronic predisposing: Obesity, chronic cough, constipation, heavy lifting, pelvic mass
Iatrogenic: hysterectomy, pelvic surgery, continence procedures (Burch colposuspension)
Tx Weight reduction Quit smoking Physio Pessaries
Surgical
Uterine prolapse: hysterectomy, hysteropexy
Vaginal vault prolapse: Sacrocolpopexy, Sacrospinous fixation
