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Uterine prolapse during pregnancy is rare, with an estimated incidence of one in every 10,000 to 15,000 deliveries. Usually, ligaments and pelvic floor muscles hold the uterus and place it in its position.The weakening of muscles and ligaments due to damages or stretching can cause prolapse, dropping the uterus into the vagina(1)(2). The treatment is planned according to the degree of prolapse.
Read on to know the causes, signs, and treatment of uterine prolapse in pregnancy and its complications.
Does A Uterine Prolapse Affect Pregnancy?
A prolapsed uterus may cause the following complications(2)(3).
- Preterm labor
- Difficulty during labor and delivery
- Cervical discomfort
- Cervical desiccationiXA health condition causing the loss of flexibility and degenerative changes in the cervixand ulceration
- Urinary tract infection
- Acute urinary retention
- FetaliXA serious complication of bacterial infection affecting young infantsand maternal sepsis
- Postpartum hemorrhageiXA complication of childbirth associated with excessive blood loss after delivery
Complex cases of uterine prolapse may cause abortion of the fetus. Complications may occur even after childbirth(4).But do not panic since extreme complications and problems due to uterine prolapse usually occur when the condition is ignored. The symptoms of uterine prolapse seldom go unnoticed, and you are likely to feel it before the problem gets worse.
Signs And Symptoms Of Uterine Prolapse During Pregnancy
Here are some of the common symptoms of uterine prolapsemanbet安卓版(5)(6).
- A visible protrusion from the vagina
- Sensation of a bulge in the vagina
- Pelvic heaviness
- Pressure, heaviness, and a dragging sensation in the vagina
- Back pain
- Urinary incontinence – the feeling of incomplete emptying
- A feeling of incomplete emptying of the bowel
The symptoms of uterine prolapse are usually most noticeable during thethird trimester.See a doctor for antepartum care if you notice or feel the symptoms.
Prolapse is unlikely to be present before pregnancy. If present, it may resolve during pregnancy but may reappear after childbirth(4).
Causes Of Uterine Or Cervical Prolapse During Pregnancy
Pelvic muscles may weaken due to several reasons and increase the chances of uterine prolapse. The following conditions and factors may increase the risk of developing uterine prolapse(2)(4)(7).
- Trauma to the pelvic musclesduring vaginal childbirth may stretch and weaken the muscles. It increases the chances of developing uterine prolapse in subsequent pregnancies.
- Multiple pregnanciesandmultiple deliveries, like in the case of delivering twins or triplets.
- Delivering a large babythrough vaginal birth.
- Subsequent pregnancies with short intervalscould also make the uterus susceptible to prolapsing.
- Congenital connective tissue disorderscould cause pelvic muscles and ligaments to remain weak, which increases the chances of uterine prolapse.
- Physiological changesof the uterus, ligaments, and muscles of the body during pregnancy.For instance, hormonal changes during pregnancy could cause relaxation of ligaments. It may increase the risk of uterine prolapse.
- Chronicintra-abdominal pressuredue to persistent straining for bowel movement or repeated lifting of heavy weights.
Be watchfulYour doctor will determine the exact cause of uterine prolapse after performing diagnostic steps.
Diagnosing Uterine Or Cervical Prolapse During Pregnancy
Healthcare practitioners can diagnose the prolapse throughpelvic examination. The doctor may ask the patient to perform a Valsalva maneuver, a breathing technique, which can help the doctor examine the full extent of the prolapse(8). The doctor may suggest anMRIof the pelvis to further confirm the diagnosis(9).
Treatment Of Uterine Or Cervical Prolapse During Pregnancy
The treatment approach depends on the stage of prolapse, thestage of pregnancy,and if the patient has any other complications. Your doctor may suggest the following treatment and care measures during pregnancy(10).
- Maintaininggenital hygienemay help prevent the development of infections and other complications.
- The doctor may place a small device calledpessaryinto the vagina to prevent the uterus from collapsing. The pessary is kept in place until the onset of labor.
Things to consider- If other conservative treatment steps are ineffective, then the doctor may perform a laparoscopic uterine suspension where the uterus is surgically suspended back to its original position. If uterine prolapse persists even as you approach the due date, the doctor may consider obstetric interventions such as performing a cesarean section to prevent complications.
Can You Prevent Uterine Prolapse During Pregnancy?
There is no particular way to prevent uterine prolapse. Observing certain precautions and making some changes in lifestyle may help reduce the risk of developing uterine prolapse. The following are some ways you can take care of your maternal health to minimize the chances of developing uterine prolapse(9)(11).
- Lose weight if you are overweight
- Include fiber and fluids in your diet to avoid constipation or excessive straining
- Avoid lifting heavy weights
- Take medical advice in case you have chronic cough since it can strain pelvic organs and muscles
- In mild cases, you may perform Kegel exercises to strengthen your pelvic floor muscles. Make sure to discuss with your healthcare practitioner or physiotherapist before performing any exercise during pregnancy.
An existing uterine prolapse may resolve after childbirth, and there is also no risk to the baby after delivery.
Uterine prolapse may occur as a result of one factor or due to a combination of factors. It can be categorized into stages.
Stages Of Uterine Prolapse
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There are different stages of uterine prolapse, depending on how far the uterus dropped into the vagina. The following are the four stages(5)(7).
- Stage I:The uterus drops down to the upper half of the vagina. The most distal portion of the prolapse is >1cm above the level of the hymen.
- Stage II:The uterus has dropped down nearly to the opening of the vagina. The most distal portion of the prolapse is ≤1cm proximal or distal to the hymen.
- Stage III:The uterus protrudes out of the vagina.The most distal portion of the prolapse is >1cm below the hymen but protrudes no farther than 2cm less than the total length of the vagina.
- Stage IV:The uterus is completely out of the vagina.There is a complete eversion of the vagina.
Can You Get Pregnant And Give Natural Birth With A Prolapsed Uterus?
Early diagnosis and proper management of the condition can lead to a safe pregnancy or gestation period(2). Various published case studies have reported successful natural birth with a prolapsed uterus(4)(6). However, there may be an increased risk for fetal distress and the mother due to uterine prolapse. Seeking prompt treatment can help have a trouble-free delivery.
Frequently Asked Questions
1. Does uterine prolapse increase the risk of miscarriage?
The complications arising from uterine prolapse could vary from cervical infection to a miscarriage. However, most cases of uterine prolapse are treated, resulting in successful vaginal delivery(12).
2. Does bed rest help uterine prolapse?
Bed rest is a crucial part of the uterine prolapse intervention strategy. Even though the treatment plan may vary per each woman’s condition, bed rest is a common suggestion for everybody(13).
3. Can uterine prolapse during pregnancy affect future pregnancies?
Uterine prolapse during pregnancy may recur during a future pregnancy. Therefore, doctors recommend inserting a pessary inside the vagina to ease the symptoms (14).
4.How does uterine prolapse during pregnancy affect delivery?
During delivery, a pregnant woman with uterine prolapse will likely experience inadequate cervical dilatation, cervical laceration, and obstructive labor. In severe cases, hysterorrhexis at the lower uterus, fetal death, and maternal morbidity could also be possible (4).
Uterine prolapse during pregnancy may result in preterm labor, cervical discomforts, labor difficulties, urinary tract infection, fetal andmaternal sepsisiXA serious complication of an infection occurring during pregnancy, childbirth, or following an abortion, and postpartum hemorrhage. Some cases may result in pregnancy loss, such as miscarriage or stillbirth. A noticeable protrusion in the vagina, the sensation of the bulge in the vagina, back pain, pelvic heaviness, and urinary incontinence are some of the symptoms of uterine prolapse. Large babies, multiple pregnancies, trauma, congenital connective tissue disorders, and short intervals between pregnancies can increase the risk of uterine prolapse. Good hygiene practices, inserting pessaries into the vagina, or laparoscopic uterine suspension are done to manage uterine prolapse depending on the severity
Infographic: Aspects That Influence Treatment Choice For Uterine Prolapse
Healthcare providers recommend vaginal pessaries or surgery to treat uterine prolapse during pregnancy. This depends on various factors and expected outcomes in each woman. Read through the infographic to know the factors influencing the treatment choice for uterine prolapse during pregnancy.
Illustration: Momjunction Design Team
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Key Pointers
- Uterine prolapse happens when the pelvic floor muscles become weak due to damage and stretching.
- Previous pregnancies and deliveries may increase the risk of uterine prolapse.
- Back pain, pelvic heaviness, or visible protrusion from the vagina are some symptoms of uterine prolapse.
- Kegel exercises, avoiding heavy weight lifting, a good diet, and moderate physical activity can help prevent uterine prolapse.
- Early diagnosis and proper management are crucial for a safe pregnancy and delivery.
Uterine prolapse is a condition where the uterus drops down into the vagina. Learn about its causes, signs and symptoms, diagnosis and treatment in this video.
References:
2. Buyükbayrak, E. E., Yılmazer, G., Ozyapı, A. G., Kars, B., Karşıdağ, A. Y., & Turan, C.Successful management of uterine prolapse during pregnancy with vaginal pessary: a case report: Journal of the Turkish German Gynecological Association, 11(2), 105–106. (2010).
3. Tsikouras, P., Dafopoulos, A., Vrachnis, N., Iliodromiti, Z., Bouchlariotou, S., Pinidis, P., … & Von Tempelhoff, G. F.Uterine prolapse in pregnancy: risk factors, complications and management: The Journal of Maternal-Fetal & Neonatal Medicine, 27(3), 297-302. (2014).
4.曾,C。杨,F。,C,朱,J。,关,X。,& Liu, J.Uterine Prolapse in Pregnancy: Two Cases Report and Literature Review: Case reports in obstetrics and gynecology, 2018. (2018).
5. Doshani, A., Teo, R. E., Mayne, C. J., & Tincello, D. G.Uterine prolapse: BMJ (Clinical research ed.), 335(7624), 819–823.(2007).
6. De Vita, D., & Giordano, S.Two successful natural pregnancies in a patient with severe uterine prolapse: A case report. Journal of medical case reports, 5, 459. (2011).
7.Prolapsed uterus: Department of Health & Human Services, State Government of Victoria, Australia. (2017).
8.Pelvic Organ prolapse: American family Physician. (2010).
9.Uterine Prolapse: John Hopkins Medicine. (n.d.).
10. Latika, Nanda S, Chauhan M, Malhotra V.Pregnancy with third degree uterine prolapse-a rare case report.International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 5, 579-81. (2016).
11.What to do about pelvic organ prolapse: Harvard Health Publishing. (2014).
12. Jeong Ok Kim et al;Uterine prolapse in a primigravid woman; US National Library of Medicine (2016).
13. Rakhi Gupta and Girija Tickoo;Persistent Uterine Prolapse During Pregnancy and Labour; US National Library of Medicine (2012).
14.Treatment; NHS
