Genital prolapse is a common gynecological condition characterized by the descent of the vaginal wall or uterus, with varying degrees of severity. Pregnancy can occur in women with certain types of prolapse, but complications are likely when the cervix protrudes outside the vaginal opening. Treatment during pregnancy may involve repositioning the cervix and using a pessary, while the management of labor depends on the prolapse condition at that time.

2. “Genital prolapse is one of the common
clinical gynecological condition. It
includes descent of the vaginal wall or
the uterus. Pregnancy can occur in
women with cystocele, rectocele and
uterine prolapse. It is a form of hernia.”

4. Pregnancy is not uncommon in first
degree uterine prolapse with cyctocele
and rectcele.
Pregnancy, is however, unlikely when
the cervix remains outside the introitus
and continuation of pregnancy in 3rd
degree prolapse is an extremely rare
event.
The incidence of prolapse is about 1 in
250 pregnancies.

7. Uterine prolapse can be categerized as
incomplete or complete
When the uterus is partially displaced
into the vagina but does not protrude it
is called incomplete uterine prolapse.
 When a portion of the uterus protrudes
from the vaginal opening it is called
complete uterine prolapse.

8. The condition is graded by its severity,
determined by how far the uterus has
descended.
First Grade / First Degree
Second Grade / Second Degree
Third Grade / Third Degree
Fourth Grade / Fourth Degree

9. First grade : Uterus descended to the
upper vagina
Second grade : Uterus descended to
the introitus
Third grade : Cervix has descended
outside the introitus
Fourth grade : Cervix and uterus have
both descended outside the introitus

10. The main causes is weakness of the
structures supporting the organs in
position.
Previou difficult labour and trauma during
labour
Delivery of the large baby
Being over weight or obese
Chronic contipation or straining with
bowel movements
Chronic cough or bronchitis
Repeated heavy lifting

11. Multiparity
Grandmultipara
Obesity
Prior pelvic surgery
Family history of weakness in connective
tissue

12.  Fall of womb
 White discharge per vaginam
 Pelvic pain
 Bachache Bladder symptoms like frequency
of urination, inability to pass urine comletely,
stress incontinence, rectal symptoms
 Difficulty in defecation
 Constipation
 There are signs of cystocele, uterine prolapse
with ulcerated hypertrophic elongated cervix
and urethrocele.

13. There is aggracation of the morbid
anatomical changes inprolapse such as
marked hypertrophy and edema of the
cervix, first degree becomes second
degree, cyctocele and rectocele become
pronounced and there is aggravation of
stress incontinence.
These are marked during early
pregnancy and the effects are due to the
weight of the uterus and increased
vascularity.

14. Vaginal discharge may be copious and
decubitus ulcer may develop when the
cervix remains outside the introitus.
There is chance of incarceration, if the
uterus fails to rise above the pelvis by
16th week of pregnancy.

15. There is an increased chance of...
Abortion
Discomfort due to increased ailments
Premature rupture of the membranes
Chorioamnionitis.

16. There is an increased chance of...
Early rupture of the membranes
Cervical dystocia
Prolonged labour due to non-
dilatation of cervix
Obstruction due to sagging cyctocele
and rectocele
Operative interference

17. There is an increased chance of...
Subinvolution
Uterine sepsis

18. Performing kegal exercises regulary
Treatment and prevention of constipation
Avoidance of heavy lifting and promotion
of correct lifting
Control coughing
Avoidance of over weight gain

19. During pregnancy...
If the cervix is outside the itroitus, the
cervix is to be replaced inside the vagina
and is to be kept in position by a ring
pessary.
The pessary is to be kept until 18-20th
week of prenancy.
Make the patient lay in bed with foot end
raised to 20 cm.

20. Cover it with a gause soaked in glycerine
and acriflavine to relieve edema and
congestion.
If reposition is not possible, then
termination is done.
If the cervix remains outside even later
months, the patient is admitted in the
hospital at the 36th week.

22. RING PESSARY

23. During Labour...
The patient should be in bed not only to
prevent early rupture of the membranes but
also to facilitate replacement of the
prolapsed cervix inside the vagina.
Intravaginal plugging soaked with glycerine
and acriflavine not only helps in reduction of
cervical edema but also facilitates its dtation.
Prophylactic antibiotic should be
administered in case of premature rupture of
the membranes or when the cervix remains
outside.

24.  Mannual stretching of the cervix or pushing
up the custocele or rectocele posterior to the
presenting part durine uterine contractions
facilitates progressive descent of the head.
 If the head is deeply enagaged, with the
cervix remaining thin but undilated, delivery
may be facilitated by Duhrssen's incision at 2
and 10 o'clock positions followed by
ventouse extraction or forceps application.
 If the head is high up and or the cervix
remains edematous, thick or undialated,
cesarean section is a safe procedure.

25. During Puerperium...
The patientshould lay flay on the bed.
If the mass remains outside, it should be
covered with gauze soaked in glycerine and
acriflavine.
If subinvolution is evident, a ring pessary
may be put in until involution is completed.