Uterine prolapse in pregnancy: risk factors, complications and management

Abstract

Presentation of uterine prolapse is a rare event in a pregnant woman, which can be pre-existent or else manifest in the course of pregnancy. Complications resulting from prolapse of the uterus in pregnancy vary from minor cervical infection to spontaneous abortion, and include preterm labor and maternal and fetal mortality as well as acute urinary retention and urinary tract infection. Moreover, affected women may be at particular risk of dystocia during labor that could necessitate emergency intervention for delivery. Recommendations regarding the management of this infrequent but potentially harmful condition are scarce and outdated. This review will examine the causative factors of uterine prolapse and the antepartum, intrapartum and puerperal complications that may arise from this condition as well as therapeutic options available to the obstetrician. While early recognition and appropriate prenatal management of uterine prolapse during pregnancy is imperative, implementation of conservative treatment modalities throughout pregnancy, these applied in accordance with the severity of the uterus prolapse and the patient's preference, may be sufficient to achieve uneventful pregnancy and normal, spontaneous delivery.

Uterine Prolapse during Pregnancy

“…Having more than one vaginal birth and the use of forceps or vacuum during prolonged labour are the important risk factors for prolapse. Other predisposing factors include obesity, connective tissue disease, chronic coughing, ethnic origin and family history (3,4). In our case, the prolapse occurred soon after delivery of her first baby and persisted during the subsequent pregnancies.…”

Case Report: Pregnancy Associated Uterine Prolapse

“…There is no valid evidence about the benefits of systemic antibiotic treatment. Pessary treatment is often required only until the fifth month of pregnancy when the uterus usually lifts out of the pelvis, and, as a result, the symptoms related with uterine prolapse are alleviated [2,8]. Abnormalities of labor are observed more frequently in women with pregnancy-associated uterine prolapse.…”

“…Moreover, uterine prolapse may cause cervical infection and bleeding which eventually lead to the scarring and fibrosis of cervical tissue. These alterations may result in secondary arrest of the cervical dilatation [8,9]. It has been previously reported that spontaneous vaginal delivery is successfully achieved in 40% to 80% of the women with pregnancy-related uterine prolapse, but instrumental deliveries and deliveries by cesarean section occur with some frequency.…”

“…It has been previously reported that spontaneous vaginal delivery is successfully achieved in 40% to 80% of the women with pregnancy-related uterine prolapse, but instrumental deliveries and deliveries by cesarean section occur with some frequency. Nevertheless, spontaneous vaginal delivery is recommended in affected women [7,8]. If the uterine prolapse is left untreated, it will almost certainly recur in future pregnancies.…”

“…Obstetricians should keep in mind the fact that careful monitoring of the cervical dilatation rate is essential for the early detection of both cervical dystocia and labor abnormalities. Another issue to be remembered is that it would be more difficult to manage primary postpartum hemorrhage caused by uterine atony in women presenting with uterine prolapse during pregnancy because uterine prolapse can interfere with the effective application of manual uterine compression [8][9][10].…”