However if you suspect uterine prolapse and you have tried everything as suggested by your gynecologist or reproductive endocrinologist or infertility specialist then consider a uterine suspension surgery. This is a great question and the answer is dependent upon who you talk to, but most reconstructive surgeon would tell you to be safe and get a Caesarean Section.
Because the trauma of a vaginal birth can potentially compromise the tissue or mesh supporting your uterus and then you have a greater chance of having prolapse again and will need another surgery. By delivering via C-section the chance of uterine support compromise decreases and this decreases the need for another prolapse surgery.
Please click here:. Prolapse and Infertility. View Larger Image. Infertility, Uterine Prolapse and Hysteropexy Patients who have a prolapsed uterus and infertility can sometimes be treated with a uterine suspension i.
She had added that had breastfeeding her baby for 8 months. Her complaints of vaginal bulging started approximately one years ago and increased day by day. She was an academician not require heavy-lifting work which may increase the risk of POP. Other systems had no problems on physical examination with transabdominal ultrasound assessment.
She stated desire for surgical correction of the genital prolapse with sterilization. However, she became pregnant before the scheduled appointment on the day of operation. The first prenatal visit was performed at 6 th weeks of gestational age and a single alive fetus was observed with transvaginal ultrasounography.
We re-examined her vaginally and according to POPQ system fourth degree uterine prolapse was observed similar like before pregnancy. At 12 th weeks visit, we recommended inserting a pessary, but she refused due to the discomfort of a foreign body in her vagina and potential risk of infection. Then, we recommended bed rest in a moderate Trendelenburg position and use of moisturizer to prevent cervical dryness. Close follow-up with vaginal examination and translabial ultrasound at each visit, prolapse persisted up to 26 weeks of gestational age.
When 32 weeks control, antenatal corticosteroids were administered to accelerate fetal lung maturation due to the potential risk of preterm birth. Cesarean section was performed with spontaneous rupture of membranes at 37 weeks. The operation was uneventful and concomitant bilateral tubal ligation was performed with Pomeroy's technique. We didn't carry out uterosacral ligament plication at the time of cesarian section to correct the uterine prolapse. However, prolapse was not observed and two days later she was discharged with her healthy baby.
One week later and 6 weeks later postoperative controls were performed with transabdominal ultrousound assessment and vaginal examinations. Uterine prolapse was still not observed. Patient continued to be followed up every 6 months with vaginal examination and transvaginal ultrasound performed to detect any residue bulging or mild recurrent prolapse at our urogynecology unit.
Overall, at the end of 2 years follow-up period, uterine prolapse did not recur. Physiological increases in cortisol and progesterone levels during pregnancy lead to softening of pelvic tissues as well as apical cardinal and uterosacral supportive ligaments. For this reason, acute onset of POP in pregnancy is a more common condition than pregnancy with pre-existing POP [ 3 , 8 ]. The four categories of uterine prolapse are:.
The pelvic floor and associated supporting connective tissues can be weakened or damaged in many ways including:. Treatments for uterine prolapse include surgical and non-surgical options, the choice of which will depend on general health, the severity of the condition and plans for a future pregnancy.
Treatment options include:. Stage I and II uterine prolapse in particular can be helped by pelvic floor muscle exercises, but they need to be done correctly and practised long enough to strengthen the muscles. Although the following information may give you some ideas about how to do PF exercises, it is imperative to seek professional help from a pelvic floor physiotherapist if you have a prolapse.
Familiarising yourself with the muscles of the vagina, urethra and anus gives you a better chance of performing the exercises correctly. You can perform these exercises lying down, sitting or standing. Ideally, aim for five or six sessions every day while you are learning the exercises. After you have a good understanding of how to do the exercises, three sessions each day is enough. Before you start, direct your attention to your pelvic floor muscles.
Try to relax your abdominal muscles, buttocks and leg muscles. Squeeze and lift the urethra, vagina and anus and hold the tension for three seconds if you can. Release completely. Then perform the exercises, which include:. A pessary is a flexible device which can be fitted into the vagina to support the uterus. There are different shapes and sizes of pessary, which can be prescribed and fitted by a suitably trained health professional.
Women can be taught to remove and re-insert their pessary much like a tampon. However, regular reviews with your gynaecologist or doctor are necessary. Vaginal pessaries can be an effective way of reducing the symptoms of a prolapse, but they will not be appropriate for everyone. Together with pelvic floor exercises, they may provide a non-surgical solution to manage a uterine prolapse.
In moderate to severe cases, the prolapse may have to be surgically repaired. In laparoscopic surgery, instruments are inserted through the navel. Consequently, the uterus sags, slips down into or protrudes out of the vagina. Uterine prolapse could be either complete or incomplete. When the uterus falls significantly and some tissue protrudes outside of the vagina leads to complete prolapse, whereas if the uterus is only partly sagging down the vagina causes incomplete prolapse.
There is no particular age for uterine prolapse. It can occur to women of any age. But it generally affects postmenopausal women who have had one or more vaginal deliveries. If the uterine prolapse is not severe, it does not bring about any signs or symptoms as such.
Weakening of the pelvic muscles and supportive tissues triggers uterine prolapse.
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