PROLAPSE UTERUS

-P.NIRUMALAN

ANATOMY OF UTERUS :

•PYRIFORM SHAPED•9cm length, 6.5 cm width, 3.5 cm thickness•Weighs 60 g•Divided anatomically and functionally into body &

cervix•Uterine cavity – triangular – 3ml•Cavity communicates above with openings of

fallopian tubes• Lateral angle connecting to fallopian tubes is called

cornual end•Wall of uterus – 3 layers –peri,myo,endo metrium

Position of uterus :

SUPPORTS OF THE UTERUS :

•De Lancey -3 level systems of support• Level I – Uterosacral and cardinal ligaments support

the uterus and the vaginal vault• Level II – pelvic fascias and paracolpos which

connects the vagina to the white line on the lateral pelvic wall through the arcus tendinous• Level III – Levator ani muscle supports the lower

one third of vagina

UTERINE PROLAPSE

•DESCRIPTION: Uterine prolapse is loss of the normal support mechanism resulting in descent of the uterus down the vaginal canal. In the extreme, this may result in the uterus descending beyond the vulva to a position outside the body (procidentia).• PREVALENCE: Some degree of uterine descent is

common in parous women.• PREDOMINANT AGE: Late reproductive and

beyond; incidence increases with the loss of oestrogen. •GENETICS: No genetic pattern.

ETIOLOGY AND PATHOGENESIS :

CAUSES / RISK FACTORS :•Loss of normal structural support as a result of trauma(childbirth)•Surgery•Chronic intra-abdominal pressure elevation• Intrinsic weakness or atrophy resulting from oestrogen loss.

•Most common sites of injury are the cardinal and uterosacral ligaments and the levator ani muscles that form the pelvic floor, which may relax or rupture. •Rarely, increased intra-abdominal pressure from a

pelvic mass or ascites may weaken pelvic support and result in prolapse. Injury to or neuropathy of the S1 to S4 nerve roots may also result in decreased muscle tone and pelvic relaxation.

CLASSIFICATION OF PROLAPSE :

•Anterior vaginal wall :Upper two third – cystocoeleLower one third – urethrocoele•Posterior vaginal wall :Upper one third – enterocoeleLower two third – rectocoele•Uterine descent- Descent of the cervix into the vagina- Descent of the cervix up to the introitus- Descent of the cervix outside the introitus

•Procedentia – All of the uterus outside the introitus

SIGNS AND SYMPTOMS :

• Pelvic pressure or heaviness (a sense of “falling out”) • Mass or protrusion at or beyond the vaginal entrance • New onset or paradoxical resolution of urinary incontinence • Drying, thickening, chronic inflammation, and ulceration of the exposed tissues, which may result in bleeding, discharge, or odour

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