UTERO–VAGINAL PROLAPSE

Definition ,, Form of hernia that implies a descent of the uterus and /or the vagine ’’

Clinical forms Vaginal prolapse of the anterior wall - CYSTOCELE - URETHROCELE Vaginal prolapse of the posterior wall - ENTEROCELE - RECTOCELE Uterovaginal prolapse – represent the descent of the uterus, always accompanied by some descent of the upper vagina.

UTERO–VAGINAL PROLAPSE

UTERO–VAGINAL PROLAPSE

UTERO–VAGINAL PROLAPSE

Uterovaginal prolapse – 3 degree First degree – when there is a slight descent of the uterus but the cervix remains within vagina Second degree – the cervix projects beyond the vulva, when the patient strains Third degree ( Complete Procidenta) – the entire uterus has prolapsed outside the vulva and most or all of the vagina is everted.

UTERO–VAGINAL PROLAPSE

Etiology Anatomical considerations Functional considerations: Constitutional factor ( the imperfect development of the supporting tissues) Gestational factor Endocrine factor Mechanical factor ( tumoral or pelvic inflammatory diseases)

Symptoms ’’ Something falling out ’’ Pelvic pains Difficulty or discomfort in micturition or defaecation Backache Bleeding or vaginal discharge

Diagnosis Inspection of the vulva- when the patient is straining or coughing Vaginal examination Rectal examination

Differential diagnosis Hypertrophy of the cervix Tumours or cysts of the vagina Tumours or cysts of the uterus Inversion of the uterus

Management Preventive Active treatment ( surgical) Vaginal procedures Abdominal procedures Combined procedures

Preventive Prophylactic measures - in childbirth - Avoidance of pushing at delivery, before the full dilatation of the cervix Avoidance of prolongation of the second stage of labor Avoidance of fundal pusching attempting to expel the placenta Careful repair in accurate layers of all vagina walls and perineal tears and incisions Early ambulation and pelvic floor exercices in the puerperinum