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CASE REPORT  
Year : 2013  |  Volume : 6  |  Issue : 6  |  Page : 671-673
Uterine cervical prolapse following delivery


Gynaecologic and Obstetric Clinic, Aristide Le Dantec Teaching Hospital. 1, Avenue Pasteur, PO Box 3001, Dakar, Senegal

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Date of Web Publication6-Sep-2014
 

   Abstract 

Uterine cervical prolapse concurrent with pregnancy is rare. This article reports three cases of third-degree cervical prolapse following delivery. No history of preexisting prolapse was reported. The first case was treated by hysterectomy, the second case by partial cervical excision and the third case, conservatively. Uneventful recoveries and any further complications were noted. We believe that an extensive uterine cervical prolapse needs surveillance and can be managed conservatively.

Keywords: Labor, postpartum, pregnancy, uterine cervical prolapse

How to cite this article:
Guèye M, Ndiaye-Gueye MD, Mbaye M, Cisse ML, Kane-Gueye SM, Moreau JC. Uterine cervical prolapse following delivery. Ann Trop Med Public Health 2013;6:671-3

How to cite this URL:
Guèye M, Ndiaye-Gueye MD, Mbaye M, Cisse ML, Kane-Gueye SM, Moreau JC. Uterine cervical prolapse following delivery. Ann Trop Med Public Health [serial online] 2013 [cited 2020 Sep 28];6:671-3. Available from: http://www.atmph.org/text.asp?2013/6/6/671/140255

   Introduction Top


Prolapse of the uterine cervix in pregnancy is uncommon, with an incidence of 1 in 10,000-15,000 deliveries. [1] Genital prolapse may develop initially during pregnancy. However, in the majority of cases, pregnancy is superimposed on a preexisting prolapse. Intrapartum complications include cervical dystocia and prolonged or obstructed labor as cervical dilatation may begin outside the introitus, and difficulty is added by edema of fibrous nature of cervix. [2] The management strategies reported in the literature are conservative management, use of vaginal pessary, laparoscopic uterine suspension, and concomitant cesarean hysterectomy with abdominal sacrocolpopexy. [3]

We present three cases of uterine prolapse which were managed by different strategies.

Case 1

A 28-year-old lady, gravida 7, para 6, was referred to our unit for puerperal uterine inversion. She vaginally delivered a healthy female baby weighing 2860 g at 38 weeks of pregnancy in another center. No history of any other gynecological disorder was present. She had a history of five spontaneous vaginal deliveries. On examination, she was conscious and well oriented but markedly pale, dehydrated, tachycardiac, and febrile. Systemic examination revealed no abnormality. On per-abdominal examination, the uterus height was corresponding to 15 weeks of gestation. On local examination, the cervix was extravulvar, enlarged, edematous, and bleeding [Figure 1]. Laboratory values were Hb 7.9 g/dl; leukocyte count 9.200/μl; and platelet count 150.000/mm 3 . Due to ongoing cervical bleeding, hysterectomy was performed by laparotomy (adnexa were conserved). She was discharged on the fourth postpartum day with an uneventful recovery.
Figure 1: Uterine cervical prolapse of case 1

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Case 2

A 32-year-old lady, 2 gravida, 2 para, was admitted for externalization of the cervix. She delivered vaginally a healthy female baby weighing 3400 g, 24 hours before. There was a prolapse of an edematous cervix (approximately 4-6 cm outside the introitus), partially slough and hemorrhagic. Due to the cervix aspect, a partial excision of the cervix was decided (like conization). The surgery and postoperative period were uneventful. Edema of the cervix gradually decreased and had completely resolved by the fourth postoperative day. At follow-up 5 weeks later, there was no sign of uterine prolapse.

Case 3

A 29-year-old lady, 6 gravida, 5 para, was referred to our unit for cervix prolapse following vaginal delivery of a healthy male baby weighing 3350 g. Her obstetrics history included five full-term normal vaginal deliveries of infants weighing between 3000 and 3500 g. According to the patient's statement, prolapse had occurred immediately after delivery. The cervix was extravulvar [Figure 2]. Perineal hygiene and bed rest in Trendelenburg position have been recommended. The patient's cervix remained prolapsed in the early postpartum period; however, it was easily reduced prior to discharge. She was discharged at day 7 and scheduled for further follow-up in the unit. At follow-up 2 weeks later, there was no sign of uterine prolapse [Figure 3].
Figure 2: Uterine cervical prolapse of case 2

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Figure 3: Cervix in place 2 weeks later (case 3)

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   Discussion Top


Prolapse of the uterine cervix in pregnancy is uncommon, with an incidence of 1 in 10,000-15,000 deliveries. [1]

Genital prolapse may develop initially during pregnancy. However, in the majority of cases, pregnancy is superimposed on a preexisting prolapse which occurs as a result of relaxation and tearing down of the support structures of the uterus.

Most of the cases reported are multipara and their pregnancies are superimposed on a pre-existing prolapse. In our three cases, the patients reported no history of prolapse before pregnancy. In the childbearing years, genital prolapse is usually due to multiparty, but traumatic and prolonged labor and operative vaginal deliveries may also contribute. [1]

When some degree of prolapse is present before pregnancy, it usually will persist until the pregnancy progresses to the stage where spontaneous correction occurs. This spontaneous correction is due to the uterus becoming an abdominal organ in the second trimester. However, the uterine descensus condition may be aggravated by pregnancy as a result of physiologic increases in cortisol and progesterone, which lead to a concomitant softening and stretching of the pelvic tissues. [4]

Significant complications may develop during pregnancy and labor ranging from minor cervical lacerations to uterine rupture. Antenatal complications include an increased rate of abortions. Acute and gross edema of the prolapsed cervix may occur due to venous obstruction and stasis. In addition, the mechanical trauma causes ulceration and infection of the edematous cervix. Urinary tract infection may occur. The conservative treatment of long duration of bed rest is also inconvenience. Preterm labor and prenatal loss are still major complications and prolapse usually persists or recurs after labor. [5]

Intrapartum complications include cervical dystocia and prolonged or obstructed labor as cervical dilatation may begin outside the introitus, and difficulty is added by edema of fibrous nature of cervix. [2] When the prolapsed uterus causes obstructed labor, intrapartum fetal death and rupture of lower uterine segment may occur. Cervical lacerations followed by infection are quite common. Successful pregnancy outcome requires individualized treatment. [5]

The management strategies reported in the literature are conservative management, use of vaginal pessary, laparoscopic uterine suspension, and concomitant cesarean hysterectomy with abdominal sacrocolpopexy. [3] Perineal hygiene and bed rest in Trendelenburg position have been recommended and this is reported to be successful. Also, conservative management of uterine prolapse during pregnancy should be considered during the patient's counseling. [2]

An elective cesarean section near term is the safest mode of delivery in cases where the cervix is edematous and elongated. These findings may indicate labor dystocia due to the cervical parameter. [2]

However, postnatally, the uterine prolapse may recover spontaneously. [5] Two of our cases (2 and 3) were resolved completely. Hysterectomy and suspension operations represent alternative options for patients who do not wish to have future pregnancy. In our first patient we did not perform concurrent repair of the prolapse at the time of hysterectomy. One year after hysterectomy, no prolapsed organ has been observed.

Abdominal sacrohysteropexy is a safe, efficient surgical technique for treatment of uterine prolapse in women who desire to preserve the uterus. This procedure has a high success rate and is an easy technique. [6]

 
   References Top

1.Chandru S, Srinivasan J, Roberts AD. Acute uterine cervical prolapse in pregnancy. J Obstet Gynaecol 2007;27:423-4.  Back to cited text no. 1
    
2.Daskalakis G, Lymberopoulos E, Anastasakis E, Kalmantis K, Athanasaki A, Manoli A, et al. Uterine prolapse complicating pregnancy. Arch Gynecol Obstet 2007;276:391-2.  Back to cited text no. 2
    
3.Büyükbayrak EE, Yýlmazer Gl, Özyapý AG, Kars Bl, Karþýdað AY, Turan C. Successful management of uterine prolapse during pregnancy with vaginal pessary: A case report. J Turkish-German Gynecol Assoc 2010;11:105-6.  Back to cited text no. 3
    
4.Brown HL. Cervical prolapse complicating pregnancy. J Nati Med Assoc 1997;89:346-8.  Back to cited text no. 4
    
5.Yousaf S, Haq B, Rana T. Extensive uterovaginal prolapse during labor. J Obstet Gynaecol Res 2011;37:264-6.  Back to cited text no. 5
    
6.Kiilholma P, Nieminen K. Gynaecological prolapses. Duodecim 2009;125:199-206.  Back to cited text no. 6
    

Top
Correspondence Address:
Mamour Guèye
Clinique Gynécologique et Obstétricale, 1, Avenue Pasteur, BP 3001, Dakar
Senegal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.140255

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  [Figure 1], [Figure 2], [Figure 3]



 

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