Uterine prolapse

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  • 1. 1
    Uterine prolapse
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  • 2. 2010-5-6
    Definition
    The uterus gradually descends in the axis of the vagina taking the vaginal wall with it. It may present clinically at any level, but is usually classified as one of three degrees.
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  • 3. 3
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    5
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  • 6. 2010-5-6
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  • 7. 7
    Degrees of uterine prolapse
    • First degree:cervix still inside vagina
  • 2010-5-6
    8
    Degrees of uterine prolapse
    • Second degree:the cervix appears outside the vulva. The cervical lips may become congested and ulcerated
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  • 8. 2010-5-6
    Degrees of uterine prolapse
    • Third degree:completeprolapse.In the picture the uterus is retroflexed,and the outline of bladder can be seen.This is sometimes called complete procidentia.
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  • 9. 10
    Causes
    • The stretching of muscle and fibrous
    tissue
    • Increased intra-abdominal pressure
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  • 10. 2010-5-6
    11
    • In recent years,the incidence of prolapse is greatly reduced .The more liberal use of caesarean section and the elimination of labours are probably the two most important factors.
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  • 11. 2010-5-6
    12
    Symptoms
    Something coming down
    Backache
    Increased frequency of micturition
    A ‘bearing down’ sensation
    Stress incontinence
    Coital problems
    Difficulty in voiding urine
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  • 12. 2010-5-6
    13
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    14
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  • 15. 2010-5-6
    16
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  • 16. 17
    Treatment
    Pessary treatment
    Indications
    Patient prefers a pessary.
    Pelvic surgery risks
    Prolapse amenable to pessary
    The patient is not fit for surgery
    Patient wishes to delay operation
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  • 17. 18
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  • 19. www.freelivedoctor.com
  • 20. www.freelivedoctor.com
  • 21. Surgery
    • Anterior colporrhaphy
    (and repair of cystocele)
    • Posterior colpoperineorrhaphy
    (including repair of rectocele)
    • Manchester repair
    • 22. Vaginal hysterectomy
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