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Norby N, Murchison AB, McLeish S, Ghahremani T, Whitham M, Magann EF. Uterine Prolapse in Pregnancy: A Review. Obstet Gynecol Surv 2023; 78:537-543. [PMID: 37976302 DOI: 10.1097/ogx.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Importance Although not a common occurrence, uterine prolapse during pregnancy can have significant effects for pregnancy outcomes and quality of life of maternal patients. Most data about management exist as case reports; a review of these cases provides some guidance about treatment options. Objectives This review examines current literature about uterine prolapse during pregnancy to assess current information about this condition, prevalence, diagnosis, management, and outcomes. Evidence Acquisition Electronic databases (PubMed and Embase) were searched using terms "uterine prolapse" AND "pregnancy" AND "etiology" OR "risk factors" OR "diagnosis" OR "therapy" OR "management" limited to the English language and between the years 1980 and October 31, 2022. Results Upon review of 475 articles, 48 relevant articles were included as well as 6 relevant articles found on additional literature review for a total of 54 articles. Of those articles, 62 individual cases of uterine prolapse in pregnancy were reviewed including pregnancy complications, mode of delivery, and outcomes. Prevalence was noted to be rare, but much more common in second and subsequent pregnancies. Most diagnoses were made based on symptomatic prolapse on examination. Management strategies included bed rest, pessary use, and surgery (typically during the early second trimester). Complications included preterm delivery, patient discomfort, urinary retention, and urinary tract infection. Delivery methods included both cesarean and vaginal deliveries. Conclusions Although a rare condition, uterine prolapse in pregnancy is readily diagnosed on examination. Reasonable conservative management strategies include observation, attempted reduction of prolapse, and pessary use; if these measures fail, surgical treatment is an option. Relevance Our review compiles literature and known cases of uterine prolapse during pregnancy and current evidence about prevalence, diagnosis, management, outcomes, and complications of uterine prolapse during pregnancy in order to inform our target audience in their clinical practice.
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Affiliation(s)
- Nicole Norby
- Resident, Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Amanda B Murchison
- Associate Professor, Residency Director, Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Shian McLeish
- Resident, Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Taylor Ghahremani
- MFM Fellow, The University of Arkansas for Medical Sciences, Little Rock, AR
| | - Megan Whitham
- Assistant Professor, Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Everett F Magann
- Professor MFM Fellowship Director, University of Arkansas for Medical Sciences, Little Rock, AR
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Deshpande RR, Matsuzaki S, Cox KR, Foy OB, Mandelbaum RS, Ouzounian JG, Dancz CE, Matsuo K. Incidence, characteristics, and maternal outcomes of pregnancy with uterine prolapse. Am J Obstet Gynecol MFM 2023; 5:101020. [PMID: 37245607 DOI: 10.1016/j.ajogmf.2023.101020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Gravid uterine prolapse refers to abnormal descent of the uterus during pregnancy. It is a rare pregnancy complication and its clinical characteristics and obstetrical outcomes are not well understood. OBJECTIVE This study aimed to assess the national-level incidence, characteristics, and maternal outcomes of pregnancies complicated by gravid uterine prolapse. STUDY DESIGN This retrospective cohort study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population was 14,647,670 deliveries from January 2016 to December 2019. The exposure assignment was the diagnosis of uterine prolapse. The coprimary outcome measures were incidence rate, clinical and pregnancy characteristics, and delivery outcomes of patients with gravid uterine prolapse. The inverse probability of treatment weighting cohort was created to mitigate the difference in prepregnancy confounding factors, followed by adjusting for pregnancy and delivery factors. RESULTS The incidence of gravid uterine prolapse was 1 in 4209 deliveries (23.8 per 100,000). In a multivariable analysis, older age (≥40 years; adjusted odds ratio, 3.21; 95% confidence interval, 2.70-3.81); age from 35 to 39 years (adjusted odds ratio, 2.66; 95% confidence interval, 2.37-2.99); Black (adjusted odds ratio, 1.48; 95% confidence interval, 1.34-1.63), Asian (adjusted odds ratio, 1.45; 95% confidence interval, 1.28-1.64), and Native American (adjusted odds ratio, 2.17; 95% confidence interval, 1.63-2.88) race/ethnicity; tobacco use (adjusted odds ratio, 1.19; 95% confidence interval, 1.03-1.37); grand multiparity (adjusted odds ratio, 1.78; 95% confidence interval, 1.24-2.55); and history of pregnancy losses (adjusted odds ratio, 2.20; 95% confidence interval, 1.48-3.26) were the patient characteristics associated with increased risk of gravid uterine prolapse. Current pregnancy characteristics associated with gravid uterine prolapse included cervical insufficiency (adjusted odds ratio, 3.25; 95% confidence interval, 1.94-5.45), preterm labor (adjusted odds ratio, 1.53; 95% confidence interval, 1.18-1.97), preterm premature rupture of membranes (adjusted odds ratio, 1.40; 95% confidence interval, 1.01-1.94), and chorioamnionitis (adjusted odds ratio, 1.64; 95% confidence interval, 1.18-2.28). Delivery characteristics associated with gravid uterine prolapse included early-preterm delivery at <34 weeks' gestation (69.1 vs 32.0 per 1000; adjusted odds ratio, 1.86; 95% confidence interval, 1.34-2.59) and precipitate labor (35.2 vs 20.1; adjusted odds ratio, 1.73; 95% confidence interval, 1.22-2.44). Moreover, risks of postpartum hemorrhage (112.1 vs 44.4 per 1000; adjusted odds ratio, 2.70; 95% confidence interval, 2.20-3.32), uterine atony (32.0 vs 15.7; adjusted odds ratio, 2.10; 95% confidence interval, 1.46-3.03), uterine inversion (9.6 vs 0.3; adjusted odds ratio, 31.97; 95% confidence interval, 16.60-61.58), shock (3.2 vs 0.7; adjusted odds ratio, 4.18; 95% confidence interval, 1.41-12.40), blood product transfusion (22.4 vs 11.1; adjusted odds ratio, 2.06; 95% confidence interval, 1.34-3.18), and hysterectomy (7.5 vs 2.3; adjusted odds ratio, 3.02; 95% confidence interval, 1.40-6.51) were increased in the gravid uterine prolapse group compared with the nonprolapse group. Conversely, patients with gravid uterine prolapse were less likely to deliver via cesarean delivery compared with those without gravid uterine prolapse (200.6 vs 322.8 per 1000; adjusted odds ratio, 0.51; 95% confidence interval, 0.44-0.61). CONCLUSION This nationwide analysis suggests that pregnancy with gravid uterine prolapse is uncommon but associated with several high-risk pregnancy characteristics and adverse delivery outcomes.
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Affiliation(s)
- Rasika R Deshpande
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Deshpande and Cox, Ms Foy, and Drs Mandelbaum and Matsuo)
| | - Shinya Matsuzaki
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan (Dr Matsuzaki)
| | - Kaily R Cox
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Deshpande and Cox, Ms Foy, and Drs Mandelbaum and Matsuo)
| | - Olivia B Foy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Deshpande and Cox, Ms Foy, and Drs Mandelbaum and Matsuo); Keck School of Medicine, University of Southern California, Los Angeles, CA (Ms Foy)
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Deshpande and Cox, Ms Foy, and Drs Mandelbaum and Matsuo); Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Mandelbaum)
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Ouzounian)
| | - Christina E Dancz
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Dancz)
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Deshpande and Cox, Ms Foy, and Drs Mandelbaum and Matsuo); Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (Dr Matsuo).
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Arusi M, Abdulhakim E, Awol Y, Mosa H. Management of preexisting pelvic organ prolapse in pregnancy complicated with preterm premature rupture of membrane: a case report. J Med Case Rep 2023; 17:252. [PMID: 37291643 DOI: 10.1186/s13256-023-03901-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/20/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Pregnancy management is difficult when pelvic organ prolapse already exists. During pregnancy, childbirth, and the days following, clinicians may come across situations that present management dilemmas. Here, we present conservative management of preexisting pelvic organ prolapse in pregnancy complicated with preterm premature rupture of membrane up to term. CASE PRESENTATION A 35-year-old Ethiopian woman, gravida V, para IV, visited our emergency obstetrics and gynecology department at 32 weeks and 1 day of pregnancy in a prolapsed uterus on the 4th of April 2022. She was referred from primary hospital as a case of preterm pregnancy, pelvic organ prolapse, and preterm premature rupture of membrane after she presented with complaints of passage of clear liquor of 10 hours duration. She was successfully managed conservatively without application of pessary until she gave birth to a 3200 g healthy male neonate by elective cesarean section at 37 weeks of gestational age. At the same operation, cesarean hysterectomy was done. CONCLUSION Women with preexisting pelvic organ prolapse complicated by premature rupture of membrane during the third trimester of pregnancy can be treated without the use of a pessary. Our case shows the importance of conservative management, which includes strict antenatal follow-ups, lifestyle modifications, and manual uterine reduction. Due to potential intrapartum problems from induction of labor with the occurrence of severe pelvic organ prolapse, we recommend cesarean delivery. However, to determine the optimal mode of delivery, additional comprehensive study with a large sample size is vital. If definitive management is warranted after delivery, we need to take a consideration of the status of prolapse, patient's choice, and family size.
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Affiliation(s)
- Muhudin Arusi
- Department of Obstetrics and Gynecology, Worabe Comprehensive Specialized Hospital, Worabe, Ethiopia.
| | - Elham Abdulhakim
- Department of Neurology, Worabe Comprehensive Specialized Hospital, Worabe, Ethiopia
| | - Yasin Awol
- Department of Medical Laboratory, Worabe Comprehensive Specialized Hospital, Worabe, Ethiopia
| | - Hassen Mosa
- Department of Midwifery, College of Medicine and Health Sciences, Werabe University, Worabe, Ethiopia
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Askary E, Alamdarloo SM, Karimi Z, Karimzade A. A rare case of obstructed labor due to sever uterine prolapse; a case report and literature review. Int J Surg Case Rep 2022; 97:107344. [PMID: 35901546 PMCID: PMC9403023 DOI: 10.1016/j.ijscr.2022.107344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Uterine prolapse in pregnancy is a rare problem reported in literature and might increase problems such as emergency cesarean section, preterm delivery, and other materno-fetal complications. Prolapse becomes a life-threatening condition for both mother and baby when it creates a labor abstraction. PRESENTATION OF CASE Here, a 37 years old lady (BMI = 26, gestational age = 37 weeks), without any obvious risk factors, with sever uterine prolapse (stage IV) and obstructed labor was presented. Congested and incarcerated cervix along with the onset of uterine contractions led to emergency cesarean section, by incision made in fundal part of uterus, because the lower segment was not accessible or visible at all. Apical and lateral vaginal defect in the patient was corrected at cesarean section time. CONCLUSION As a result: with timely action for cesarean delivery, maternal-fetal complications were reduced, however the correction of apical uterovaginal defects during cesarean time is possible and improves the quality of life of women in the reproductive age.
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Affiliation(s)
- Elham Askary
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shaghayegh Moradi Alamdarloo
- Department of Obstetrics and Gynecology, School of Medicine, Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding author at: Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Zand St., P.O.BOX: 7134844119, Shiraz, Iran.
| | - Zinat Karimi
- Department of Obstetrics and Gynecology, School of Medicine, Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anushe Karimzade
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Vargas BAM, García AEV, Mendoza RLA, Sarmiento CAG, Vargas EHL. Management of pelvic organ prolapse during pregnancy: Case report. Case Rep Womens Health 2022; 35:e00421. [PMID: 35607457 PMCID: PMC9123191 DOI: 10.1016/j.crwh.2022.e00421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022] Open
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Lu D, Liu F, Ning X, Zhang H, Huang Y. Anterior vaginal wall protrusion in pregnancy: a case report. J Int Med Res 2020; 48:300060519899524. [PMID: 31975632 PMCID: PMC7113705 DOI: 10.1177/0300060519899524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Vaginal prolapse rarely complicates pregnancy. We experienced a 36-year-old, gravida 3, para 1 woman who presented at 37 weeks’ gestation with gestational diabetes mellitus and a large anterior vaginal prolapse that could not be reduced manually or by bed rest. After obtaining consent, a cesarean section was successfully performed, and a live neonate delivered. The prolapsed anterior vagina recovered spontaneously following the cesarean operation. A vaginal prolapse in pregnancy is rare. Elective or emergency cesarean section is a possible treatment option when the prolapse cannot be reduced manually or by bed rest. Our case highlights the importance of routine obstetric examinations for early detection of a vaginal wall prolapse.
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Affiliation(s)
- Dajiang Lu
- Department of Obstetrics, the People’s Hospital of Qiannan, Duyun, Guizhou, P.R. China
- Dajiang Lu, Department of Obstetrics, the People’s Hospital of Qiannan, 9 Wenfeng Road, Duyun, 558000 Guizhou, P.R. China.
| | - Fang Liu
- Department of Obstetrics, the People’s Hospital of Qiannan, Duyun, Guizhou, P.R. China
| | - Xue Ning
- Department of Gynecology, the People’s Hospital of Qiannan, Duyun, Guizhou, P.R. China
| | - Hua Zhang
- Department of Obstetrics, the People’s Hospital of Qiannan, Duyun, Guizhou, P.R. China
| | - Yan Huang
- Department of Gynecology, the People’s Hospital of Qiannan, Duyun, Guizhou, P.R. China
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Uterine prolapse in a primigravid woman. Obstet Gynecol Sci 2016; 59:241-4. [PMID: 27200317 PMCID: PMC4871943 DOI: 10.5468/ogs.2016.59.3.241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/24/2015] [Accepted: 10/28/2015] [Indexed: 11/24/2022] Open
Abstract
Uterine prolapse during pregnancy is an uncommon condition. It can cause preterm labor, spontaneous abortion, fetal demise, maternal urinary complication, maternal sepsis and death. We report the case of uterine prolapse in a 32-year-old healthy primigravid woman. She had no risk factors associated with uterine prolapse. She was conservatively treated, resulting in a successful vaginal delivery. This report is a very rare case of uterine prolapse in a young healthy primigravid woman, resulting in a successful vaginal delivery.
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Karatayli R, Balci O, Gezginç K, Yildirim P, Karanfil F, Acar A. Alternative surgical approach for the management of uterine prolapse in young women: preliminary results. J Obstet Gynaecol Res 2013; 39:1465-70. [PMID: 23855402 DOI: 10.1111/jog.12084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 01/08/2013] [Indexed: 11/27/2022]
Abstract
AIM To demonstrate an alternative surgical approach for the management of uterine prolapse in young women by a technique that was previously defined for post-hysterectomy vaginal vault suspension in published work and also to demonstrate successful operative results. METHODS The study population consisted of 12 women aged 28-41 years who had stage 4 uterine prolapse and who were surgically treated by abdominal hysteropexy using autogenous rectus fascia strips. Operative results and postoperative follow-up Pelvic Organ Prolapse Quantification and Prolapse Quality of Life results were recorded. RESULTS Mean age of patients was 35.5 ± 4.1 years (range, 28-41). Mean parity in the study group was 2.6 ± 1.0 (range, 1-5). Mean operation time was 32.0 ± 5.2 min (range, 25-42). All patients were discharged on the postoperative 3rd day and no complications were observed postoperatively. Mean follow-up period was 20 ± 7.0 months (range, 12-36). All of the patients had complete remission for uterine prolapse and none of the patients had complaints related to the operation. CONCLUSION Abdominal hysteropexy operation using rectus fascia strips provides a safe and alternative approach for the management of uterine prolapse in young women who desire to preserve their uterus. But further analysis is needed to confirm our results.
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Affiliation(s)
- Rengin Karatayli
- Department of Obstetrics and Gynecology, Necmettin Erbakan University Meram Medical School, Konya, Turkey
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