UTERINE

PROLAPSE
PRESENTED BY-

POOJA SONI
MSC FINAL YEAR STUDENT

Department Of Obstetrics & Gynecology

INTRODUCTION

The uterus (womb) is an organ of the female

reproductive system. It is shaped like an upside
down pear and is located inside the pelvis. The
uterus, bladder and bowel are supported by a
hammock of muscles slung between the tailbone
(coccyx) and the pubic bone. These muscles are
known as the pelvic floor, Ligaments and
connective tissue also anchor the uterus in place.
If these tissues are weakened or damaged, the
uterus can slip down into the vagina.

Uterine Prolapse

DEFINITION
Uterine Prolapse is the downward
displacement of the uterus into the
vaginal canal or a gradually descends
of the uterus in the axis of the
vagina taking the vaginal wall with it.
INCIDENCE: In 95% of the
cases of Prolapse the patient is
multipara and implication is that child
bearing is an important causal factor.

Uterine Prolapse

Uterine Prolapse

Uterine Prolapse

Uterine Prolapse

TYPES OF UTERINE
PROLAPSE: -

Vagino uterine prolapse: -In this the

primary vaginal prolapse drags the uterus
down.
Utero vaginal prolapse: - In this the
descent of uterus causes version of
vagina.

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Uterine Prolapse

SYMPTOMS

Something coming down

Increased frequency of mituration
A bearing down sensation
Stress incontinence
Difficulty in voiding urine

Feeling like sitting on a small ball

Difficult or painful sexual
intercourse
Low backache
Feeling of heaviness or pulling in
the pelvis
Vaginal bleeding
Increased vaginal discharge

DEGREES OF UTERINE
PROLAPSE: -

1st degree: - the cervix and uterine

body descends from its normal
position upto vagina.

SECOND DEGREE PROLAPSE

2nd degree: - the cervix descends at or

outside the vaginal introitus but the
body of uterus still lies with in the
vagina.

3rd degree: - whole of the

uterus descends outside the
vaginal introitus and vagina
is completely inverted. It is
also called PROCIDENTIA.

THIRD DEGREE PROLAPSE

PREDISPOSING FACTORS:

CONGENITAL WEAKNESS OF SUPPORT: -

this is the most important of all

factors and operates in both
nulliparous and multiparous
prolapse. There is weakness of
muscle tissues allowing rapid
dilatation of birth canal as well as
uterine prolapse.
Shortness of vagina.
Uterine reteroversion.

Downward pressure attempts on

fundus to deliver placenta also
weaken the ligament. Early bearing
down pains when head still lies at
the level of cervix with improper
cervical dilatation.
Delivery of head without proper
emptying of bladder. This results in
tear of bladder or cystocele.
Improper management during
Puerperium.

Activating factors:

INCREASED INTRA-ABDOMINAL
PRESSURE: - This can be due to
chronic cough, lifting heavy weights
or straining at stools.
Increased weight of uterus that may
be the result of subinvolution.
Traction on uterus by vaginal
prolapse or cervical polyp. So
descent of vagina can lead to uterine
prolpase.

MULTIPLE PREGNANCIES AND VAGINAL

DELIVERIES one or more vaginal
births. Tissue trauma sustained during
childbirth, especially with large babies
or difficult labor and delivery, is
typically the cause of muscle weakness.
AGE (especially the years past
menopause )The loss of muscle tone
and the relaxation of muscles, . (The
female hormone estrogen plays an
important role in maintaining the
strength of the pelvic floor).

Obesity Places additional strain on

the supportive muscles of the pelvis
Activities Increasing the pressure in
the abdomen and pelvis, including:

Severe or long-standing constipation

Chronic coughing (especially in smokers
)
Heavy lifting

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Uterine Prolapse

DIAGNOSIS

HISTORY
EXAMINATION
Diagnose uterine Prolapse by
evaluating symptoms and performing a
pelvic exam. During this exam, will insert
a speculum (device that allows the
doctor to see inside of the vagina) to
examine the vaginal canal and uterus.,
To determine the degree of prolapsed

Diagnose uterine Prolapse with a medical history and

physical examination of the pelvis.

Examine in standing position and while are lying down and

ask to cough or strain to increase the pressure in
abdomen.

Specific conditions, such as ureteral obstruction due to

complete prolapse, may need an intravenous pyelogram
(IVP) or renal sonography. Dye is injected into vein, and a
series of X-rays are taken to view its progress through
bladder.

Ultrasound

TREATMENT
Pessary treatment

Patient
prefers a Pessary.
INDICATIONS:

Pelvic surgery unaviodable

risks

The patient is not fit for

surgery

Patient wishes to delay

TREATMENT
Vaginal pessary:
This device fits inside vagina and
holds uterus in place. Used as
temporary or permanent treatment,
vaginal Pessaries come in many shapes
and sizes.

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Uterine Prolapse

TREATMENT

Surgery:

Several different types of surgery

can be used to treat a severe genital
prolapse. These procedures include:

surgery to repair the tissue that

supports the prolapsed organ
surgery to repair the tissue around the
vagina
surgery to close the opening of the
vagina
surgery to remove the womb
(hysterectomy)

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Uterine Prolapse

SURGERY
Anterior colporrhaphy
(and repair of cystocele)
* Posterior
colpoperineorrhaphy
(including repair of
rectocele)
* Vaginal hysterectomy

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Uterine Prolapse

30

Uterine Prolapse

31

Uterine Prolapse

32

Uterine Prolapse

PREVENTION TECHNIQUES
Early

visits to HC provider = early

detection
Teach Kegels exercises during PP period
Obesity loss of excess abdominal fat with
dietary modifications and regular exercises
Chronic constipation To have big, soft
and formed stools. Usually, eating lots of
fruit, vegetables and fibre will help. Dont
strain when using bowels
Avoid heavy lifting weight

SUMMARY
As far we have discussed
introduction, definition, types,
causes, risk factors, diagnosis and
treatment, prevention techniques.

RESEARCH INPUT
FINITE ELEMENT STUDIES OF THE DEFORMATION OF THE PELVIC
FLOOR.
MARTINS JA, PATO MP, PIRES EB, JORGE RM, PARENTE M,
MASCARENHAS T.
AUTHOR INFORMATION
ABSTRACT
This article describes research involving finite element simulations of
women's pelvic floor, undertaken in the engineering schools of Lisbon in
collaboration with the medical school of Oporto. These studies are
motivated by the pelvic floor dysfunctions that lead namely to urinary
incontinence and pelvic organ prolapse
. This research ultimately aims at: (i) contributing to clarify the primary
mechanism behind such disorders; (ii) providing tools to simulate the pelvic
floor function and the effects of its dysfunctions; (iii) contributing to
planning and performing surgeries in a more controlled and reliable way.

Skeletal muscles are transversely isotropic with a single fiber

direction, embedded in an isotropic matrix. The fibers considered
in this work may be purely passive, or active with input of
neuronal excitation and consideration of the muscle activation
process. The first assumption may be adequate to simulate
passive deformations of the pelvic muscles and tissues (namely,
under the extreme loading conditions of childbirth). The latter
may be adequate to model faster contractions that occur in time
intervals of the same order as those of muscle activation and
deactivation (as in preventing urinary incontinence in coughing
or sneezing). Numerical simulations are presented for the active
deformation of the levator ani muscle under constant pressure
and neural excitation, and for the deformation induced by a
vaginal childbirth.

CONCLUSION

Uterine prolapsed is the abnormal

position of the uterus. It occurs
mainly due to the mismanaged
labor. It can be treated with the
manual method. Surgical method
sometime required. It should be
treated with the time otherwise
complication occurs and it needs
complete or partial hysterectomy

REFERENCE

Jacob A.A,Comprehensive Textbook of Midwifery and

Gynecological Nursing,3rd edition,New Delhi, Jaypee;2012,
Fraser DM, Cooper MA.Myles,Textbook for Midwives,15th
edition, Philadelphia:churchill livingstone elsevier;2009
Dutta DC,Textbook of Gynecology,6th edition, New central
book agency, Calcutta,2004,
http://www.nhs.uk/conditions/prolapse-of-theuterus/pages/treatment.aspx
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002477/
http://www.mayoclinic.com/health/uterineprolapse/DS00700/DSECTION=symptoms
http://www.mayoclinic.com/health/uterineprolapse/DS00700/DSECTION=treatments-and-drugs
Medical Surgical Nursing (Volume 2) by Lewis, Heitkemper,
Dirksen, OBrien, Bucher.

THANKS FOR YOUR

ATTENTION