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Case Presentation On Uterine Prolapse

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27 views

Case Presentation On Uterine Prolapse

Uploaded by

pragatibhakat3
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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CASE PRESENTATION

ON UTERINE
PROLAPSE
SUBMITTED TO
SUBMITTED BY
SR.B.SAHA. PRAGATI
BHAKAT
NTS,NRSMCH
INTRODUCTION

 Pelvic organ prolapse ( pop) is one of the common clinical condition met
in day to day gynecological practice especially among the parous
women .The entity includes descent of the vaginal wall and / or the
uterus .It is infact a form of hernia .
 It is the herniation of the uterus from its natural anatomical
location into the vaginal canal , through the hymen, or through the
introitus of the vaginal .This is due to the weakening of its surrounding
support structures .
DEFINITION

 Prolapse of uterus refers to a colapse , descend or change in


the position of the uterus in relation to surrounding structures
in the pelvis.
 Uterine Prolapse is the downward displacement of uterus , into
the vaginal canal , or a gradually descends of uterus in the axis
of the vaginal , taking the vaginal wall with it.Uterine prolapse
is a form of genital prolapse of female . It is also called pelvic
organ prolapse or prolapse of the uterus ( womb).
CAUSES

Birth injury – It is 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 stiched or toned up

Peripheral nerve injury – pudendal nerve injury during child birth causes prolapse which
is reversible in 60% and it may be responsible for stress in continence also.

Bear down – before full dilatation of cx , when bladder is not empty .

Heavy work out just after the delivery , without any rest or pelvic floor exercise .

Rapid succession of pregnancies .


CONT.

 Loss of pelvic support


 Post partum cough
 Congenital weakness for nulliparous women
 Acquired defects for multiparous women .
 Menopausal atrophy – after menopause due to withdrawal of
oestrogen there is atrophy of genital tract and it supports.
 Aggravating factors – small fibroids , or traction on uterus , pelvic
tumors .
 Obesity
 Women who have softer connective tissue .
RISK FACTORS

 One or more pregnancies and vaginal births .


 Giving birth to a large baby .
 Increasing age .
 Obesity .
 Prior pelvic surgery .
 Chronic constipation or frequent straining during bowel movement .
 Family history of weakness in connective tissue .
 Being Hispanic or white .
TYPES

 Uterovaginal prolapse – It is the prolapse of uterus, cervix, and


upper vagina. This is the most common type. It is accompanied
by cystocele .

 Congenital Prolapse – there is usually no cystocele .often seen


in nulliparous so called as nulliparous prolapse. The uterus
herniated down along with inverted upper vagina .
DEGREE

 Depending on severity it is 3 types-


 First degree - The uterus descends from normal anatomic position into upper
vagina The external os remains inside the vaginal. The cx rests in lower part of
vagina .
 Second degree – The cx is at or outside the vaginal introitus , but uterine. Body
remains inside vagina. The cervix is at vaginal opening .
 Third degree- Also known as Procidentia or complete prolapse .Uterine cx and
body descends to lie outside the introitus .
 Procidentia – Prolapse of uterus with eversion of entire vagina. It is inevitably
associated with cystocele and enterocele .
CLINICAL MANIFESTATIONS

Sensation of heaviness or pulling in the pelvis .


Urinary problems .
Trouble having bowel movement
Dragging pain in pelvis .
Backache .
Feeling of something coming down from vagina , while moving
about .
Excessive white or blood stained discharge per vagina .
DIAGNOSTIC EVALUATION

Inspection and palapation ( vaginal , rectal , rectovaginal )


Examination in squatting position .
Pelvic examination dorsal and standing position .
Patient is asked to valsalva’ s maneuver .
Degree of the uterine Prolapse
MANAGEMENT
 Non surgical treatment
Pessary – Ring pessary are made up of inert plastic of different size , can be Left in to
a place up to one year .
Shelf pessaries are useful in severe uterovaginal prolapse .
Indication – During and after pregnancy awaiting involution tissue .
As a therapeutic test to confirm the surgery might help.
. For relief of symptoms while the patient is awaiting for surgery .
when the patient is medically unfit or refuses surgery .
Complications – vaginal ulceration , incarceration leading to discharge and bleeding .

A Pessary may be placed inside the vagina to support pelvic organs for patient who
don’t desire surgery .It relive the symptoms but doesn't cure the condition .
Early cases of UV prolapse are helped by pelvic floor exercise particularly during
purperium and while waiting to undergo surgical treatment .It is used to tone up pelvic
musculature .It is done 3 times a day for 20 min.
KEGEL EXERCISE
CONT.

 Surgical treatment –
Anterior colporrhaphy
Posterior colporrhaphy
Enterocele repair
Paravaginal repair
Vaginal Hysterectomy
. Manchester Repair ( Fothergill’s operation)
colpocleisis .
CONT.

 Preventive management
 women should be advised to avoid in quick succession .

 LABOUR - avoid bearing down


 breech or forceps delivery before full dilatation of cx
 avoid prolongation of the 2 nd stage
 perform episiotomy if tears or overstretching of perineum.
 . Avoid credes method , episiotomy or tears should be carefully
sutured .
 PURPERIUM – treat chronic cough and constipation
 avoid strenuous activity and standing for prolonged time .
COMPLICATIONS

 Hemorrhage within 24 hours following surgery or between 5 th and 10


th day –
Urinary retention
. Infection leading cystitis
. Wound sepsis
vault cellulitis
. Dyspareunia
. Vesicovaginal fistula
cervical stenosis
. Infertility
. Cervical incompetence
EXTRA TERM

 Prolapse – from Latin prolapsus a slipping forth falling or slipping


out of place of a part of viscus .
 prolapse is divided in three types –
 . Uterine Prolapse , vaginal prolapse and vault prolapse .
 Anterior wall prolapse –
1. cystocele – bladder base descends with upper 2/3 of anterior
vaginal wall. It represents a weakness in the investing fascia.
2. urethrocele – urethra descends with lower third of anterior vaginal
wall.

. Posterior vaginal wall prolapse –


3. Enterocele – due to posterior wall prolapse and usually associated
with herniation of pouch of Douglas and its content ( bowel and
omentum) .
SUMMARIZATIAON

 Introduction
 Definition
 Causes
 Risk factors
 Types
 Degree
 Clinical manifestation
 Diagnostic Evaluation
 Management
 Complication .

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