Prolapse of Uterus

Abhishek Joshi Ashvinbhai
F.Y.P.B.Sc.Nursing Student
Govt. of College of Nursing
Jamnagar.

 Introduction
 Definition
 Causes
 Types of Prolapse
 Degrees of Prolapse
 Diagnosis & Investigations
 Sign & Symptoms
 Management

 It is one of the common clinical condition met in day
to day gynecological practice
 It is most often seen in multiparous women.
 It is a form of herniation
 Uterine prolapse can happen to women of any age,
but it affects post menopausal women who had one
or more vaginal deliveries.
 The incidence of prolapse is about one in 250
pregnancies.

 Uterine prolapse occurs when pelvic floor muscles
and ligaments stretch and weaken, providing
inadequate support for the uterus . The uterus then
slips down into or protrudes out of the vagina.
 Weakening of the pelvic muscles that leads to uterine
prolapse can be caused by:
1) Damage to supportive tissue during pregnancy and
child birth
2) Effects of gravity
3) Loss of oestrogen

 Round ligaments
 Broad ligaments
 Pubocervical ligaments
 Pelvic floor muscles
 Utero sacral ligaments

 Uterine prolapse means the uterus has
descended from its normal position in the
pelvis farther down into the vagina.
 Uterine prolapse is a form of female genital
prolapse It is also called pelvic organ
prolapse or prolapse of the uterus
(womb).

 1)Birth injury : it is a important cause. A perineal
tear is less harmful than the excessive stretching of
the pelvic floor muscles and ligaments that occur
during child birth because over stretching causes
atonicity where as torn muscle could be stitched or
toned up.
 2) Peripheral nerve injury: such as pudendal nerve
injury during child birth causes prolapse which is
reversible in 60% and it may be responsible for
stress in continence also.

 3) Bear down : before full dilatation of the cervix and
when the bladder is not empty.
 4) Heavy work just after delivery without any rest or
pelvic floor exercises
 6) Delivery of a big baby:also stretches the perineal
muscles and leads to patulous introitus and prolapse.
Precipitate labour and fundal pressure may be
responsible for prolapse.
 7) Rapid succession of pregnancies.
 8) Loss of pelvic support which results in uterine
prolapse
 9) Post partum cough

1) Congenital weakness: congenital weakness of the uterus and vagina is the
most important causative factor of the utero-vaginal prolapse in is
nulliparous women.
2) Acquired defects: in multiparous women overstretching of the ligaments
3) Menopausal atrophy: After menopause due to withdrawal of oestrogen
there is atrophy of the genital tract and its supports.
 In women due to atrophy of the ligamentous supports of the uterus and
vagina prolapse develop.
 4) Activating factors: the utero vaginal prolapse is aggravated by-
a) Small fibroids or traction on the uterus.
b) Pelvic tumors.
 5) Body type: some women have softer connective tissue than others
which means the ligaments that support your pelvic organs loosen more
easily, they are more prone to stretch during pregnancy and child birth so
there may be a higher risk for developing a prolapse.
 6) obesity.

Retroverted
uterus
Anteverted uterus

1. Uterovaginal prolapse:
 It is the prolapse of uterus, Cx & upper vagina.
 Commonest type
 It is accompanied by Cystocele.
2. Congenital prolapse:
 No cystocele
 Often seen in nulliparous, so called as
nulliparous prolapse.
 Cause-congenital weakness of supports of Us.

 FIRST DEGREE: The uterus descends down from
its anatomical position (external os at the level of
ischial spines) but the external os still remains inside
vagina.
 SECOND DEGREE: The external os protrudes
outside the vaginal introits but the uterine body still
remains inside the vagina

 THIRD DEGREE: The uterine cervix and body
descends to lie outside the introitus. It is also known
as Procidentia OR complete prolapse.
 Procidentia – Prolapse of the uterus with eversion of
entire vagina. It is inevitably associated with
cystocele and an enterocele

 Hematology
 Rectal exam
 Pelvic exam
 Vaginal exam
 USG
 X-ray
 MRI

 Cystic swelling in the vagina
 Chronic inversion of the uterus
 Hypertropy of the cervix
 All other causes of low backache and urinary
symptoms
 Virginities: congestion of the vagina in case
of severe virginities may give the feeling of
fullness of vagina.

 utero-vaginal prolapse may be visible during
inspection of the vulva.
 In case of minor prolapse it may become visible
on straining.
 Rectal examination also differentiate between
rectocele and enterocele.

 Feeling of something coming down per vagina ⇨ discomfort on
walking.
 Backache or dragging pain in the pelvis
 Dyspareunia
 Urinary symptoms : (in presence of cystocele)
• Difficulty in passing urine ⇨ elevate anterior vaginal wall for
bladder evacuation
• Incomplete evacuation lead to frequent desire to pass urine
• Urgency and frequency of maturation may also be due to cystitis
• Painful maturation is due to infection
• Stress incontinence is usually associated due to urethrocele
• Retention of urine

The Management of Uterine prolapse is described
under the following headings.
1.prevention
2.physiotherapy
3.pessary
4.surgical treatment

Repeated childbirth with short intervals cause UV prolapse
• Women should be advised to avoid pregnancies in quick succession
Labour
• 1st stage
▫ Avoid bearing down
▫ Breech or forceps delivery before full dilatation of cervix shouldn’t be attempted
• 2nd stage
▫ Avoid prolongation of this stage
▫ Perform episiotomy if tears or overstretching of perineum is feared
• 3rd stage
▫ Avoid Crede’s method
▫ Episiotomy or tears should be carefully sutured
Puerperium
• Treat chronic cough and constipation
• Avoid strenuous exercises and standing for prolonged time

 Early cases of UV prolapse are helped by
pelvic floor exercises Particularly during
puerperium and while waiting to undergo
surgical treatment.
 Kegel exercises are used to tone up pelvic
musculature
These exercises are done 3 times a day for 20
min each

 A mechanical device for correcting and controlling
UV prolapse
 A pessary does not cure UV prolapse
 It only holds the genital tract in position
 Advised for patients who cannot undergo surgery
Types
 1.Ring pessary
 2.Hodge pessary

Indications
 During pregnancy (1st trimester)
 During puerperium
 Unfit for surgical treatment
 Patient’s choice

Management
 Choice of pessary ( ring pessaries commonly used)
 Size (depends upon size of vagina)
 Sterilization
 Insertion
before insertion the pessary is kept in hot water for few
minutes so that pessary become soft and easy to insert
 Follow up
 pessary should be removed ,cleaned and reinserted at regular
intervals of 6-12 months.

 Vaginal Hysterectomy – most common operation and its
indications are:
- Post-menopausal prolapse
-Uterine pathology like small fibroids or adenomyosis
-Menstrual disorders such as dysfunctional uterine bleeding
-Prolapse during childbearing age , after completion of
family
 Burch Operation – for relief of symptoms of cystocele.

 Anterior Colporrhaphy – for anterior vaginal
wall prolapse.
 Posterior Colporrhaphy – for repair of the
posterior vaginal wall and perineum.
 Manchester Repair (Fothergill’s Operation) –
for repair of uterovaginal prolapse. Carried out in
women of child bearing age and haven’t
completed their families and insist on
preservation of uterus

1. D.C. DATTA’S ; ‘‘A TEXT BOOK OF OBSTETRICS’’
SEVENTH EDITION;PUBLISHED BY NEW CENTRAL BOOK
AGENCY
MEDICAL PUBLISHERS (P) LIMITED;KOLKATA;
P.NO.312 TO 314.
2.PV BOOKS; ‘‘ A TEXT BOOK OF MATERNAL HEALTH NURSING’’
FIFTH EDITION;EDITED BY R.K.GUPTA;P.NO.497 TO 500.
3.MYLES; ‘‘A TEXT BOOK FOR MIDWIVES’’ SIXTEENTH EDITION;
INTERNATIONAL EDITION;PUBLISHED BY SAUNDERS
ELSEVIER;
EDITED BY JAYNE MARSHALL & MAUREEN RAYNOR
P NO.-477 TO 479 & 486 TO 488.
4. WEBPAGE; ‘‘WWW.WIKIPEDIA.COM &
WWW.ENCYCLOPEDIA.COM’’;
TOPIC OF UTERINE PROLAPSE;TEXT AND PICTURES OF
ANAEMIA

Prolapse of Uterus

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