uterine prolapse
Post on 07-May-2015
1.248 Views
Preview:
TRANSCRIPT
Uterine Prolapse
Prepared by: Ms. Mayuri Patel
Uterine Prolapse is the downward
displacement of the uterus into the vaginal canal or a gradually descends of the uterus in the axis of the vagina taking the vaginal wall with it.
Definition
Supports conveniently grouped
under three tier system
1. UPPER TIER Endopelvic fascia covering the
uterus Round ligaments Broad ligaments with intervening
pelvic cellular tissues
Support of the uterus
Cervico vaginal junction• Fibromuscular tissue surrounding the vessels
and nerves this is important direct support of the uterus.
Pelvic cellular tissues• In this connective tissue and smooth muscles .• The blood vessels and nerve supply to uterus,
bladder and vagina pass through it from the lateral pelvic wall.
• The pelvic cellular tissue condense surrounding them and give direct support
Middle tier
• This condensation of the tissues surrounding the supravaginal cervix and vagina down to the superior layer of the fascia covering the levator ani constitute a tough endopelvic facia covering the cervico vaginal junction.
• It condenced and reinforced by plain muscles to form ligaments – mackendrot’s, uterosacral and pubocervical.
3. INFERIOR TIERMusculofacial tone of the hollow vagina by the
facial condensation at the vault and by the pelvic floor.
Positional support to the anterior wall Pelvic floor tissue • Strong condensation of pelvic floor tissue• Below – posterior urethral ligament.• Laterally – pubocervical ligament Bladder Support of posterior vaginal wall • Endopelvic fascial sheath covering the vagina
and rectum• Uterosacral ligament to lateral wall of the
vault • Levator ani with its facial covering
Support of vagina
Predisposing factorsAcquired Vaginal delivery with consequent
injury to the supporting structure overstretching of the
mackenrodt’s and uterosacral ligament.
overstretching of the perineum subinvolution of the supporting
structure
Etiology
congenitalCongenital weakness of the supporting structures is responsible for the nulliparous prolase•short vagina•increased paravaginal tissue laxity•occult spina bifida associated with neurological abnormalities
postmenopausal atrophy increased increases intra abdominal
presser as in chronic cough& constipation
increased weight of the uterus as in fibroid or myohyperplasia
asthenia & undernutrition traction by anterior vaginal wall or
cervical polyp
Aggravating factors
Clinical types
Vaginal prolapse 1.Anteriorwall:
cystocele: formed by laxity & descent the 2/3 rd of anterior vaginal wall as the bladder is closely related to the area, there is herniation of the bladder through the lax anterior wall.
Urethrocele
formed by laxity & descent the 1/3 rd of lower anterior vaginal wall as the urethra is closely related to the area, there is herniation of the urethra thorough the lax anterior wall
Posterior wallRelaxed perineum
Torn perineal body protrudes gaping introitus with the buldge of the lower part of the posterior wall.
Rectocele
Primary Enterocele: formed by laxity of
the upper 1/3 rd of posterior wall., there is herniation of the pouch of Douglas through the lax wall, may contain omentum or gut hence called enterocele.
Secondary:May occur following either
vaginal or abdominal hysterectomy
Vault prolaps
Uterovaginal: This is the commonest type. cystocele
occurs first by traction effect on the cervix causing retroversion of the uterus. Intra abdominal presser has got piston like effect on the uterus thereby pushing it down into vagina.
Congenital: There is no cystocele. the uterus
descends down along with the inverted upper vagina often seen in nulliparous.
Uterine prolaps
First degree: The cervix droops
into the vagina. The uterus descends down from its normal position(external os at the level of the ischial spine)but external os still remains inside the vagina.
Degree of uterine prolaps
Second degreeThe external os protrudes out
the vaginal introitus but the uterine body still remains inside the vagina. The cervix sticks to the opening of the vagina.
Third degreeThe uterine body descends
to lie outside the inroitus. The cervix is outside the vagina.
Minor prolapse of the uterus may not cause any
problemsMore severe prolapse can cause:
• Increased vaginal discharge.• Feeling that something is coming out of the vagina• Dragging sensation in the lower abdomen and back.
If cystocele is present, symptoms include:• Difficulty in starting and stopping urination, Urinary
frequency.• A feeling that the bladder needs emptying again soon
after urination• Problems controlling the bladder.• Frequent urinary infections may result if the bladder
never empties properly.
SIGNS & SYMPTOMS
If Rectocele is present, symptoms include: Difficulty emptying the bowel, in spite of a constant
feeling that the rectum is full and needs to be emptied. Constipation can become a problem.
Some common Symptoms of Uterine Prolapse: Difficult or painful sexual intercourse Low backache. Feeling of rectal fullness. Constipation. Sensation of heaviness or pulling in the pelvis. Vaginal discharge Frequent urinary tract infections. Sensation of fullness in the vagina. Protrusion of pink tissue from the vagina that may be
irritated or itchy.
PREVENTIVE CONSERVATIVE SURGERY
TREATMENT
EFFECTIVE ANTENATAL CARE: -nutritional supplements, antenatal hygiene &
physiotherapy with relaxation exercisesINTRANATAL CARE: to prevent premature bearing down efforts to prevent premature application of forceps before
the cervix is fully dilated to avoid prolonged 2nd stage to avoid too much fundal pressure to expel out
the placenta to perform timely & adequate episiotomy to repair the perineal injuries immediate &
accurately.
Preventive
POSTNATAL CARE: -to prevent undue distension of bladder -to encourage early ambulance -to encourage the pelvic floor exercises
GENERAL MEASURES: -to avoid the strenuous activities 6 months
following delivery -to avoid future pregnancy too soon
1. assurance:2. improvement in nutritional status3.ExerciseSpecial exercises, called Kegel exercises, can
help strengthen the pelvic floor muscles.4. Vaginal pessary
Concervative
1.Anterior colporraphy Correct cystocele and urethrocele. To exercise a portion of the relaxed
anterior vaginal wall to mobilize the bladder push it upwards after cutting the vesico-vaginal ligaments.
Surgery
2. ColpoperineorraphyTo repair the prolaps of posterior vaginal
wall.It repair torn perineal bodyTightening of the pararectal facia.3. Pelvic floor repair4. fortergill’s operation Preliminary dilatation and curratgeAmputation of the cervixPalication of the mackenrodt’s ligament in
front of the cervix.Anterior colporrhaphy Colpoperineorrhaphy5. Vaginal hysterectomy
Thanks You!
top related