1. UTERO–VAGINAL PROLAPSE

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

3. 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.

4. UTERO–VAGINAL PROLAPSE

5. UTERO–VAGINAL PROLAPSE

6. UTERO–VAGINAL PROLAPSE

7. 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.

8. UTERO–VAGINAL PROLAPSE

10. 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)

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

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

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

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

15. 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