Prolapse and Urogynaecology

Published on 10/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 10/03/2015

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Chapter 12 Prolapse and Urogynaecology

Retroversion of the uterus

An alteration from the usual anteverted position of the uterus often with a change in the curve of the uterine axis. Most of the so-called displacements are merely variations of the normal and are of little clinical significance.

Clinical features of prolapse

The onset may be gradual or quite sudden and is commoner after the menopause when the genital tract tissues begin to atrophy.

Pessary treatment

There are a number of different shapes of vaginal pessaries, the simplest to insert is a ring pessary. This is usually made of semi-rigid plastic and is inserted into the vagina so that the vaginal walls are stretched and they cannot prolapse through the introitus.

The pessary is compressed into a long ovoid shape, lubricated and gently pushed into the vagina, where it resumes its circular shape and takes up a position in the coronal plane. It must not be too tight; and correct fitting is learnt by experience. To an extent, pessary fitting is trial and error and the woman should be warned that the pessary may dislodge. A point of contact should be given so that she can be seen again without delay if this is the case.

Anterior colporrhaphy (and repair of cystocele)

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