Professional Documents
Culture Documents
Definition Assessment
Etiology Classification
Pathophysiology
Symptoms
Abnormal descent or herniation of pelvic organs from their normal attachment sites or
Pelvic organs:
Urethra
Bladder
Large intestine
Small intestine
Omentum
Rectum
Cervix
Uterus
Vagina
Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. 5th ed. ICUD-EAU; 2013.
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Multifactorial
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. 5th ed. ICUD-EAU; 2013.
Berek JS. Berek & Novaks Gynecology. 14th Ed. Amsterdam: Lippincott Williams & Wilkins; 2006.
Predispose Incite Promote Decompensate
Recreational or occupational
(frequent or heavy lifting)
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Bent AE, Cundiff GW, Swift SE. Ostergards Urogynecology and Pelvic Floor Dysfunction. 6th Ed. New York: Wolters Kluwer; 2007.
Connective Vaginal
Muscle
tissue Wall
Combination of these creates a system to support and maintain
Iliococcygeal muscle
Pubococcygeus muscle
Puborectalis muscle
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Forms flat horizontal
shelf from one pelvic
sidewall to the other
Suspending vaginal
wall to pelvis
Connective tissues and ligaments surrounds the pelvic organs and attaches
Provides lateral and apical support for anterior and posterior vagina
Uterosacral ligaments
Provide apical support by suspending and stabilizing uterus, cervix, upper vagina
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Apical support
Lateral support
Vaginal wall comprised of:
Adventitial layer
} fibromuscular layer
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Level I: Cardinal and uterosacral ligaments attaches cervix and upper
Level II: Arcus tendineus fascia pelvis and arcus tendineus rectovaginalis
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Berek JS. Berek & Novaks Gynecology. 14th Ed. Amsterdam: Lippincott Williams & Wilkins; 2006.
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. 5th ed. ICUD-EAU; 2013.
Differ in each individual
Can be asymptomatic
prolapse symptoms
of life
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Hoffman BL, et al. Williams
Gynecology. 2nd ed. New
York: McGraw-Hill; 2012.
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
POP can be assessed by:
Visual descriptors
Describe prolapse by what actually sees e.g. anterior wall prolapse, apical vaginal
wall prolapse, cervical prolapse
Previously describes by the structures thought to be prolapse behind vaginal wall
e.g. cystocele, rectocele, enterocele
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Visual Descriptor
A. Normal pelvic
anatomy
B. Anterior wall
prolapse or
cystocele (bladder)
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Berek JS. Berek & Novaks Gynecology. 14th Ed. Amsterdam: Lippincott Williams & Wilkins;
2006.
Hymental plane = 0
Measured in centimeter
Above/proximal hymen = (-)
Below/distal hymen = (+)
Tamiselvi A, Rane A. Principles and practice of urogynaecologoy. India:Springer;2015.
Berek JS. Berek & Novaks Gynecology. 14th Ed. Amsterdam: Lippincott Williams & Wilkins; 2006.
Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. 5th ed. ICUD-EAU; 2013.
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Persu C, Chapple C, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POPQ) a new era in pelvic prolapse staging .Journal of Medicine and Life. 2011;4(1):75-81.
Treatment choice depends
on type and severity of Non Pessary
symptoms
Surgical Pelvic floor muscle
exercise (Kegel)
Not life threatening
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
Hoffman BL, et al. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.