Uso de pesario para prolapso de órganos pélvicos durante el embarazo: serie de casos y revisión de la literatura

Abstract

Introducción: El prolapso de órganos pélvicos es infrecuente durante el embarazo y se asocia principalmente a mujeres multíparas. Dado que la población gestante no es la ideal para manejo quirúrgico, los pesarios son útiles para controlar los síntomas con pocos efectos adversos y contraindicaciones. Por su baja incidencia, la información reportada en la literatura se deriva de reportes de caso y las recomendaciones se extrapolan de pacientes no embarazadas. Metodología: Revisión de la literatura y exposición de casos. Resultados: Se exponen cuatro casos de gestantes con prolapso de órganos pélvicos manejadas exitosamente con pesarios hasta el final de la gestación sin presentar complicaciones serias. Conclusiones: Los pesarios son un método seguro y eficaz para el manejo de síntomas de prolapsos de órganos pélvicos durante el embarazo.

Management of pelvic organ prolapse during pregnancy: Case report

“…Pelvic organ prolapse is uncommon among pregnant women, with an incidence of one case for every 10,000 to 15,000 pregnancies ( 8 ); for this reason, there are no management guidelines or protocols, and only case reports are available, with literature reviews and recommendations extrapolated from non-pregnant patients ( 9 ).…”

“…The management of choice is conservative, with the use of vaginal pessaries, the most commonly used being the Gellhorn type, followed by the membrane ring type ( 9 ). This treatment provides vaginal support, reducing prolapse and improving symptoms of vaginal mass sensation, vaginal pressure and voiding difficulty, among others ( 12 ).…”

“…This treatment provides vaginal support, reducing prolapse and improving symptoms of vaginal mass sensation, vaginal pressure and voiding difficulty, among others ( 12 ). The absence of active vaginal infections and the possibility of patient follow-up are prerequisites for its use ( 9 ). It may have adverse effects that need to be explained to the patient, including abundant or fetid vaginal discharge, urinary or vaginal infections, vaginal or cervical erosions, difficulty voiding or defecating, and impact on sexual life ( [12] , [13] , [14] ).…”

“…Pelvic organ prolapse during pregnancy is uncommon, with only a few reported cases ( 8 ); treatment aims to minimize obstetric risks such as vaginal infection, cervical ulceration, and preterm delivery. Conservative and surgical management have been described, although there are no unified management guidelines for these patients ( 9 ). Consequently, several critical factors must be considered in this population, such as prenatal steroid administration, the type of recommended management, gestational age for delivery, and delivery route ( 9 ).…”

“…Conservative and surgical management have been described, although there are no unified management guidelines for these patients ( 9 ). Consequently, several critical factors must be considered in this population, such as prenatal steroid administration, the type of recommended management, gestational age for delivery, and delivery route ( 9 ). This report describes a patient with pelvic organ prolapse in the second trimester of pregnancy treated with conservative management with an adequate perinatal outcome.…”