Uterine Prolapse

Definition
• Uterine Prolapse is the downward
displacement of the uterus into the vaginal
canal or a gradually descends of the uterus in
the axis of the vagina taking the vaginal wall
with it
 Degrees of prolapse
• Usually, prolapse is rated by degrees:
• First-degree prolapse: the cervix rests in the
lower part of the vagina.
• Second-degree prolapse: the cervix is at the
vaginal opening.
• Third-degrees prolapse: the uterus protrudes
through the introitus.
First degree prolapse
Second degree prolapse
Second degree prolapse
Third degree prolapse
 Etiology
• Stretching of muscle and fibrous tissue.
• eg. Pregnancy and childbirth.
• Increased intra-abdominal pressure as a result of
chronic coughing, lifting of heavy objects and obesity,
place pressure on the pelvic floor.
• A constitutional predisposition to stretching of the
ligaments as a response presumably to years in the
erect position.
• Menopause and ageing increase the risk of prolapse.
(The female hormone estrogen plays an important role
in maintaining the strength of the pelvic floor).
Levels f prolapse
 Pathophysiology
• Uterine prolapse is predominantly a disorder of
parous women whereby there is damage to the
musculature, ligaments, and nerves.
• Pelvic floor muscles are contracted at rest and act
to close the genital hiatus and provide a stable
platform for the pelvic viscera.
• Levator ani (The levator ani is a broad,
thin muscle, situated on the side of the pelvis, It
supports the viscera in the pelvic cavity, and
surrounds the various structures that pass
through it) tone is essential for maintaining the
pelvic organs in place
 Pathophysiology
• Decline of normal levator ani tone by direct
muscle trauma or a denervation injury may
occur during vaginal delivery
• This results in an open urogenital hiatus(a
pause or break in continuity in a sequence or
activity) and changes to the horizontal
orientation of the levator plate, which causes
a prolapse
 Pathophysiology
• The endopelvic fascia is the connective-tissue
network that envelops all organs of the pelvis
and connects them loosely to the supportive
musculature and bones of the pelvis.
• Women with joint hypermobility and rare
connective-tissue disorders such as Ehlers-
Danlos or Marfan syndromes have a higher
prevalence of prolapse