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UTEROVAGINAL PROLAPSE
BY
DR DENNIS ALLAGOA
MANAGEMENT
PREVENTION
EXPECTANT
SURGICAL
PREVENTION
SPECIFIC MEASURES
-correct obesity
-treat chronic cough
-prevent premature bearing down during
delivery
- Avoid credes’ manoevre during delivery
of baby and placenta.
-repair of genital tract lacerations and
incisions
-Avoid forceful instrumental delivery
technique.
Prevention cont
Avoid constipation in the
puerperium
Encourage postnatal exercise(Kegel’s
exercises)
Prevention of post hysterectomy
vault prolapse by apposition of the
cardinal and uterosacral ligament to
the vaginal vault.
Family planning.
Expectant management
Physiotheraphy involving the pelvic
floor muscles.
-kegel’s exercises
-Faradism
-TENS (Trans-cutaneous Electric
Nerve Stimulation)
Applications of pessaries to the
vaginal vault.
Oestrogen replacement.
Indications for expectant
management
Physiotherapy
-prolapse discovered within six months of delivery
-minor degree of prolapse
Pessaries
-Therapeutic test to determine if symptoms are really due
to prolapse.
-Prolapse discovered during pregnancy, puerperium and
throughout the period of lactation.
-Patients not fit for surgery.
-Those who refuse surgery
-Presence of decubitus ulcers to promote their healing
before surgery while awaiting surgery
-When family size is not complete
- sacrospinous fixation
Vaginal pack
-A pack soaked in antiseptic solution to
be removed after 24 hours
-Pack is useful in securing haemostasis
and prevention of adhesions.
ANTIBIOTICS
-used until removal of catheter.
Complications of the procedures
Haemorrhage
Urinary retension
Urinary incontinence
Vault infection
Thromboembolic phenomenon
Dyspareunia
Apareunia
Constipation
Recurrent Prolapse
Mesh erosion
Vaginal stenosis
Subfertility
Premature/precipitate labour and cervical dystocia
Followup visits
The patient is seen at followup clinic at