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UTEROCEVICAL AND UTEROVAGINAL PROLAPSE
Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken and
no longer provide enough support for the uterus. As a result, the uterus slips down into
or protrudes out of the vagina. Uterine prolapse can occur in women of any age. Butit
often affects postmenopausal women who have had one or more vaginal deliveries. Mild
uterine prolapse usually doesn't require treatment, But if uterine prolapse starts
interfering with the routine activities and disrupts the normal life then benefit occurs
from the treatment. The management of uterovaginal prolapse is age and fertility related.
Not everyone requires hysterectomy. The conservative surgical operations are gaining
more popularity. Several sling operations are available now.
Fixation or suspension using your own tissues (uterosacral ligament suspension and
sacrospinous fixationJ called "native tissue repair," this is used to treat uterine
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or vaginal vault prolapse. It is performed through the vagina. The prolapsed part is
attached with stitches to a ligament or to a muscle in the pelvis. A procedure to prevent
urinary incontinence may be done at tle same time.
Colporrhaphy to treat prolapse of the anterior (front) wall of the vagina and
Lifestyle modification, healthy dieg smoking cessation.
Early treatment for chronic cough and constipation.
Promote insUrudonal delivery for proper intra-natal care.
Reinforce need for postnatal exercises
Explain Kegel's exercises for early prolapse.
Sub Health cHo o Lifestyle
Centre/HW MO modification
c/ . 1st and 2nd degree
Primary prolapse - Pelvic floor
Health exercises
Centre/UPH . Pessary insertion if
c necessary by M0 or SN
after tele-consultation
with Gynaecologist
o Physiotherapy for
backache
Community Gynaecologis o LifesVle modification USG
Health t 1st and znd degree -
Centre/ Pelvic floor exercises
Sub Division o 3rd degree - Pessary /
Hospital Surgical intervention
/District ( VH with Mc Call's
Hospital/ with AP repair OR
Tertiary conservative surgery if
Care / lady wants to preserve
Medical childbearing or is < 40
College years of age)
. Surgical management
of Vault prolapse and
associated stress
Urinary Incontinence
o Physiotherapy for
backache
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-
4. Lower Abdominal Pain
Community ASHA/MAS:
/ Sub Health oDistribution of Oral Iron and Calcium with D3 tabs
Centre a Deworming
t IEC for prevention of diarrhoeal d iseases
a Cou Partner treatment fo r P ID
Hwc/ cHo . Kits-1,2,6 r' Urine routine
Primary MO . Condoms and microscopy
Health Refer to o Tab Calcium tVit r' Stool
Centre/UPH Gynaecologist if D examination
C /no . Injectable
response to antibiotics (Cefotaxime)
treatment or o Tab
/ relapse of Metronidazole
symptoms within o Iron (Oral)
6 months or o Parenteral Iron
/if
associated with
fever/ vomiting/
abdominal
distension/
breathing
difficulty/
abdominal
lump/TB in
patient or a
family member/
within 6 weeks of
delivery or within
a month of
abortion
Community Gynaecologist o Kit-7,2,6 r' USG
Health . Condoms r' Urine routine
Centre/ o lni. Cefotaxime and microscopy
Sub Division /Cefoperazone
/ Stool examination
Hospital o Inj. Metronidazole / GI endoscopy
/District o lnj. Clindamycin r' Laparoscopy
Hospital/ o Tab Calcium tVit and SOS surgical
Tertiary D
intervention
Care / o Iron (0ral)
Medical o Parenteral lron
College r ATT for genital TB
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5 Abnormal Unheal cervrx
Community ASHA/ANM/MAS:
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Long-term- Bladder dysfunction due to cystocele formation (bladder
prolapse through the vaginal wall), stress incontinence (lnvoluntary
passage of urine), formation of enterocele and rectocele fbowel and
rectum prolapsing through the vaginal wall), vaginal vault prolapse.
