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Genital prolapse
Clinical features Click to edit Master subtitle style MERLIN ASHLY M.S 2 ND YR MSc NSG

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ETIOLOGY

1. CONGENITAL weakness of supporting structures

Congenital 2.

Acquired

Vaginal

delivery with consequent injury to supporting structures. The injury may be caused by over stretching of utero sacral ligaments bearing down efforts prior to

Premature

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Cont.
Prolonged Downward

2 nd stage of labour

pressure on uterine fundus while the delivering placenta labour

Precipitate

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Effect of acquired etiological factors


Over Over Loss Sub

stretching of perineum stretching of endo pelvic fascia of levator functions

involution of supporting structures

Clinical types of pelvic organ prolapse


Vaginal a.

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prolapse

Anterior wall prolapse of upper and descent of upper two third of anterior vaginal wall of bladder base through lax anterior wall

- cystocele
.Laxity

.Herniation

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Cont
-

urethrocele

Laxity May b.

of lower third of vaginal wall, urethra herniate through it occur along with cystocele called cysto urethrocele posterior wall perineum

-relaxed Torn

perineal body produces gaping interoitus with bulging of lower part of

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Cont
-

rectocele

Laxity

of middle third of posterior vaginal wall and recto vaginal septum of rectum through lax area

Herniation

3. Vault prolapse
-

Enterocele Laxity of upper third of posterior vaginal wall Herniation of pouch of douglas with

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cont,
-

secondary vault prolapse

Occur 4.

following vaginal or abdominal hysterectomy uterine prolapse vaginal prolapse-prolapse of uterus, cervix and upper vagina can also occur congenitally when there is weakness of supporting structures holding uterus in position

-utero It

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Degrees of uterine prolapse


First

degree-uterus starts descending down but external os remains inside vagina nd degree-external os protrudes out side vaginal interoitus , uterine body remains inside rd degree( procidentia/complete prolapse)- uterine body lies out side interoitus

Pelvic organ prolapse quantitative screening


stage 0 1 2 description No descent of pelvic organs Leading stage prolapse , does not descent below 1cm above the hymen ring Leading stage prolapse , extends from 1cm above to 1 cm below the hymen ring From 1 cm beyond the hymen ring but without complete vaginal eversion Essentially complete version of vagina

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3 4

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Morbid changes

Vaginal mucosa stretched if exposed to air becomes thickened dry and surface keratinization ulcer

-Becomes -

-Decubitus Cervix -in

the vaginal part chronic congestion , hyperplasia and hypertrophy

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Cont..
In -

supra vaginal part urinary system

becomes elongated

In

-hypertrophy

and incomplete emptying of bladder due to sharp angulation of urethra against pubo urethral ligament ureteric changes will take place

Ureters -hydro

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symptoms
Feeling Back

of something coming down from vagina ache dragging pain in the pelvis symptoms in pasing urine

Dyspareunia Urinary

-difficulty Increased Cysto

frequency and urgency of micturation urethrocele-urine escapes

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Cont.
Painful Stress

micturation due to infection incontinence due to urethrocele retension in passing stool

Urinary Bowel

symptoms

-difficulty

-excessive

white or blood stained discharge per vagina

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Diagnostic measures
Pelvic

examination in dorsal and standing position ased to perform valsalva manuever through out examination bulge of anterior vaginal wall when the pateint is asked to strain

Patient

Cystocele

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Cont
Recto

cele and enterocele of posterior vaginal wall prolapse

-Bulging Uterine -in

2nd or 3 rd degree prolapse inspection reveals a mass protruding out through interoitus the 1 st degree prolapse cervical descent below the level of ischial spines

In

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Management of prolapse
Surgical 1.

management

anterior colporrhaphy correct cystocele urethro cele

-to

Excising

a portion of relaxed anterior vaginal wall bladder and push it upwards after cutting vesico cervical ligament plicating endo pelvic fascia and pubo cervical fascia

-mobilize -

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Cont
2.

perineorrhaphy

to repair posterior vaginal wall , involves of torn perineal body para rectal fascia

-repair

-tightening 3.

repair of entero cele and vault prolapse of neck of enterocele sac by purse string suture

-obliteration

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Cont
4.

pelvic floor repair

Anterior 5.

colporrhaphy and colpo perineorrhaphy Fother gills operatio of cervix and amputation

-dialatation -plication -

of Mackerndots ligament raising cervix in to its place Anterior colporrhaphy and colpo perineorrhaphy

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Preventive measures
Adequate

ante natal and intranatal care-to avoid injury to supporting structures post natal care to avoid future pregnancies too management

Adequate Instruct

soon
Conservative 1. 2.

Oestrogen replacement therapy pelvic floor exercise

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VAULT PROLAPSE
MANAGEMENT 1. CONSERVATIVE TREMENT

2. SURGICAL TREATMENT A. Conservative treatment -trans vaginal approach

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Cont
3. Le fort operation done uder loacal anaesthesia Colpocliesis Sarcospinous colpoplexy Abdominal approach cervico pexy done in congenital nulliparous

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DEFINITION
Inversion

is a condition where the uterus become turned inside out and fundus prolapsing cervix obstetric version sub

Causes Incomplete

mucosa
Sacromatous Senile

changes of fundus , fundal pressures alsp passed away inversion due to cervical

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clinical
Incomplete-

fudus protrude through

cervix
Complete-

when whole of uterus are

inverted

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Clinical features
Symptoms Sensation Irregular

of some thing coming out vaginal disacharges vaginal discharge

vaginal bleeding

Offensive Offensive Signs

Protruding

mass has the followingglobular , no opening in the leading part

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Diagnostic measures
1.

per vaginum variety cervical rim felt

Incomplete

hgh up
Cup 2.

shaped depression at the fundus test

rectal examination

Sound -using

uterine sound for absence of urine continuity

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Treament
Anaemia

-with blood transfusion surgery

Conseervative Cutting

the posterior ring of ceervix

some fascia off a portion is hppy to meet his parents

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Thank you

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