prolapse uterus short

1. PROLAPSE
UTERUS
-P.NIRUMALAN

2. ANATOMY OF UTERUS :
•PYRIFORM SHAPED
•9cm length, 6.5 cm width, 3.5 cm thickness
•Weighs 60 g
•Divided anatomically and functionally into body &
cervix
•Uterine cavity – triangular – 3ml
•Cavity communicates above with openings of
fallopian tubes
•Lateral angle connecting to fallopian tubes is called
cornual end
•Wall of uterus – 3 layers –peri,myo,endo metrium

6. Position of uterus :

7. SUPPORTS OF THE UTERUS :
•De Lancey -3 level systems of support
•Level I – Uterosacral and cardinal ligaments support
the uterus and the vaginal vault
•Level II – pelvic fascias and paracolpos which
connects the vagina to the white line on the lateral
pelvic wall through the arcus tendinous
•Level III – Levator ani muscle supports the lower
one third of vagina

10. UTERINE PROLAPSE
•DESCRIPTION: Uterine prolapse is loss of the normal
support mechanism resulting in descent of the
uterus down the vaginal canal. In the extreme, this
may result in the uterus descending beyond the
vulva to a position outside the body (procidentia).
• PREVALENCE: Some degree of uterine descent is
common in parous women.
• PREDOMINANT AGE: Late reproductive and
beyond; incidence increases with the loss of
oestrogen.
•GENETICS: No genetic pattern.

11. ETIOLOGY AND PATHOGENESIS :
CAUSES / RISK FACTORS :
•Loss of normal structural support as a result of
trauma(childbirth)
•Surgery
•Chronic intra-abdominal pressure elevation
• Intrinsic weakness or atrophy resulting from oestrogen
loss.

12. •Most common sites of injury are the cardinal and
uterosacral ligaments and the levator ani muscles
that form the pelvic floor, which may relax or
rupture.
•Rarely, increased intra-abdominal pressure from a
pelvic mass or ascites may weaken pelvic support
and result in prolapse. Injury to or neuropathy of
the S1 to S4 nerve roots may also result in
decreased muscle tone and pelvic relaxation.

13. CLASSIFICATION OF PROLAPSE :
•Anterior vaginal wall :
Upper two third – cystocoele
Lower one third – urethrocoele
•Posterior vaginal wall :
Upper one third – enterocoele
Lower two third – rectocoele
•Uterine descent
- Descent of the cervix into the vagina
- Descent of the cervix up to the introitus
- Descent of the cervix outside the introitus

14. •Procedentia – All of the uterus outside the introitus

16. SIGNS AND SYMPTOMS :
• Pelvic pressure or heaviness (a sense of “falling
out”)
• Mass or protrusion at or beyond the vaginal
entrance
• New onset or paradoxical resolution of urinary
incontinence
• Drying, thickening, chronic inflammation, and
ulceration of the exposed tissues, which may result
in bleeding, discharge, or odour

17. THANK YOU