OG31.1 | Uterine Prolapse — Summary & Reflection

KEY TAKEAWAYS

Uterine prolapse is descent of the uterus through the vagina due to failure of pelvic floor support. The primary cause is vaginal childbirth injury to the levator ani and cardinal/uterosacral ligaments; menopause and chronic raised intra-abdominal pressure are compounding factors. Presentation is a bulge at the introitus, worse on standing and straining, with bladder, bowel, and sexual dysfunction depending on associated cystocele and rectocele. Classification: POP-Q (international, stages 0–IV, hymenal ring as reference) or traditional (1st–3rd degree descent). Stage II is the symptomatic threshold. Investigations: clinical examination in Sims' position, urine culture, urodynamics before surgery (detect occult stress incontinence), renal ultrasound if advanced. Management: conservative (PFMT, ring pessary, topical oestrogen for postmenopausal women); surgical (anterior/posterior colporrhaphy, Manchester operation for uterine preservation with cervical elongation, vaginal hysterectomy with repair, sacrocolpopexy for vault, Le Fort's colpocleisis for elderly unfit). Prevention: skilled intrapartum care, episiotomy repair, early postnatal PFMT, weight and cough management, topical postmenopausal oestrogen.

REFLECT

Consider the 52-year-old farmer in the opening case — she has Stage III prolapse, a cystocele, and no desire for further children. Which surgical procedure is most appropriate for her, and what would you tell her about the expected outcomes and risks? Now consider a 34-year-old woman with Stage II prolapse who wants two more children — would you offer surgery? What does the evidence say about pessary use in young women with prolapse? Reflect on the public health dimension: what systemic changes in antenatal and intrapartum care in India would have the greatest impact on the prevalence of prolapse?