Uterine prolapse


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Uterine prolapse

  1. 1. Prepared by: Ms. Mayuri Patel
  2. 2.  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. Definition
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  4. 4. Supports conveniently grouped under three tier system 1. UPPER TIER  Endopelvic fascia covering the uterus  Round ligaments  Broad ligaments with intervening pelvic cellular tissues Support of the uterus
  5. 5.  Cervico vaginal junction • Fibromuscular tissue surrounding the vessels and nerves this is important direct support of the uterus.  Pelvic cellular tissues • In this connective tissue and smooth muscles . • The blood vessels and nerve supply to uterus, bladder and vagina pass through it from the lateral pelvic wall. • The pelvic cellular tissue condense surrounding them and give direct support Middle tier
  6. 6.  • This condensation of the tissues surrounding the supravaginal cervix and vagina down to the superior layer of the fascia covering the levator ani constitute a tough endopelvic facia covering the cervico vaginal junction. • It condenced and reinforced by plain muscles to form ligaments – mackendrot’s, uterosacral and pubocervical. 3. INFERIOR TIER Musculofacial tone of the hollow vagina by the facial condensation at the vault and by the pelvic floor.
  7. 7.   Positional support to the anterior wall  Pelvic floor tissue • Strong condensation of pelvic floor tissue • Below – posterior urethral ligament. • Laterally – pubocervical ligament  Bladder  Support of posterior vaginal wall • Endopelvic fascial sheath covering the vagina and rectum • Uterosacral ligament to lateral wall of the vault • Levator ani with its facial covering Support of vagina
  8. 8.  Predisposing factors Acquired Vaginal delivery with consequent injury to the supporting structure  overstretching of the mackenrodt’s and uterosacral ligament. overstretching of the perineum subinvolution of the supporting structure Etiology
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  11. 11.  congenital Congenital weakness of the supporting structures is responsible for the nulliparous prolase •short vagina •increased paravaginal tissue laxity •occult spina bifida associated with neurological abnormalities
  12. 12. postmenopausal atrophy increased increases intra abdominal presser as in chronic cough& constipation increased weight of the uterus as in fibroid or myohyperplasia asthenia & undernutrition traction by anterior vaginal wall or cervical polyp Aggravating factors
  13. 13.  Clinical types
  14. 14. Vaginal prolapse 1.Anteriorwall: cystocele: formed by laxity & descent the 2/3 rd of anterior vaginal wall as the bladder is closely related to the area, there is herniation of the bladder through the lax anterior wall.
  15. 15. Urethrocele formed by laxity & descent the 1/3 rd of lower anterior vaginal wall as the urethra is closely related to the area, there is herniation of the urethra thorough the lax anterior wall
  16. 16.  Posterior wall Relaxed perineum Torn perineal body protrudes gaping introitus with the buldge of the lower part of the posterior wall. Rectocele
  17. 17.  Primary Enterocele: formed by laxity of the upper 1/3 rd of posterior wall., there is herniation of the pouch of Douglas through the lax wall, may contain omentum or gut hence called enterocele. Secondary: May occur following either vaginal or abdominal hysterectomy Vault prolaps
  18. 18.  Uterovaginal: This is the commonest type. cystocele occurs first by traction effect on the cervix causing retroversion of the uterus. Intra abdominal presser has got piston like effect on the uterus thereby pushing it down into vagina. Congenital: There is no cystocele. the uterus descends down along with the inverted upper vagina often seen in nulliparous. Uterine prolaps
  19. 19.  First degree: The cervix droops into the vagina. The uterus descends down from its normal position(external os at the level of the ischial spine)but external os still remains inside the vagina. Degree of uterine prolaps
  20. 20.  Second degree The external os protrudes out the vaginal introitus but the uterine body still remains inside the vagina. The cervix sticks to the opening of the vagina.
  21. 21.  Third degree The uterine body descends to lie outside the inroitus. The cervix is outside the vagina.
  22. 22.   Minor prolapse of the uterus may not cause any problems More severe prolapse can cause: • Increased vaginal discharge. • Feeling that something is coming out of the vagina • Dragging sensation in the lower abdomen and back. If cystocele is present, symptoms include: • Difficulty in starting and stopping urination, Urinary frequency. • A feeling that the bladder needs emptying again soon after urination • Problems controlling the bladder. • Frequent urinary infections may result if the bladder never empties properly. SIGNS & SYMPTOMS
  23. 23.  If Rectocele is present, symptoms include:  Difficulty emptying the bowel, in spite of a constant feeling that the rectum is full and needs to be emptied.  Constipation can become a problem. Some common Symptoms of Uterine Prolapse:  Difficult or painful sexual intercourse  Low backache.  Feeling of rectal fullness.  Constipation.  Sensation of heaviness or pulling in the pelvis.  Vaginal discharge  Frequent urinary tract infections.  Sensation of fullness in the vagina.  Protrusion of pink tissue from the vagina that may be irritated or itchy.
  25. 25.  EFFECTIVE ANTENATAL CARE:  -nutritional supplements, antenatal hygiene & physiotherapy with relaxation exercises INTRANATAL CARE:  to prevent premature bearing down efforts  to prevent premature application of forceps before the cervix is fully dilated  to avoid prolonged 2nd stage  to avoid too much fundal pressure to expel out the placenta  to perform timely & adequate episiotomy  to repair the perineal injuries immediate & accurately. Preventive
  26. 26. POSTNATAL CARE:  -to prevent undue distension of bladder  -to encourage early ambulance  -to encourage the pelvic floor exercises GENERAL MEASURES:  -to avoid the strenuous activities 6 months following delivery  -to avoid future pregnancy too soon
  27. 27.  1. assurance: 2. improvement in nutritional status 3.Exercise Special exercises, called Kegel exercises, can help strengthen the pelvic floor muscles. 4. Vaginal pessary Concervative
  28. 28.  1. Anterior colporraphy  Correct cystocele and urethrocele.  To exercise a portion of the relaxed anterior vaginal wall to mobilize the bladder push it upwards after cutting the vesico-vaginal ligaments. Surgery
  29. 29.  2. Colpoperineorraphy To repair the prolaps of posterior vaginal wall. It repair torn perineal body Tightening of the pararectal facia. 3. Pelvic floor repair 4. fortergill’s operation Preliminary dilatation and curratge Amputation of the cervix Palication of the mackenrodt’s ligament in front of the cervix. Anterior colporrhaphy Colpoperineorrhaphy 5. Vaginal hysterectomy
  30. 30.  Thanks You!