Case Refection

Uterine Prolapse

Disusun oleh:
Kevin Harlan 406162070

Pembimbing
Dr. dr. Cahyono Hadi, SH, Sp.OG-(K)

FA K U LTA S K E D O K T E R A N U N I V E R S I TA S TA R U M A N A G A R A
K E PA N I T E R A A N O B S T E T R I & G I N E K O L O G I
Rotasi Klinik Periode 5 Juni 19 Agustus 2017
 Kasus
Pasien Ny S, 65 th, G3P3A0

S: Pasien datang dengan keluhan keluar sesuatu dari jalan

lahir. Riwayat HT(-), DM(-), Asma(-), Alergi(-), KB (-),
Operasi(-).

O: KU: Baik (Compos Mentis)

TD: 130/80 HR: 84x/m S: 36,7OC RR: 24x/m
 Uterine Prolapse

Definition: Uterine prolapse is the herniation of the uterus

into or beyond the vagina as a result of failure of the
ligamentous and fascial supports. It often coexists with
prolapse of the vaginal walls, involving the bladder or
rectum.

Doshani A, Teo R, Mayne C, Tincello G. Uterine prolapse. BMJ 2007;335:819-23

 Epidemiology

In the Womens Health Initiative study, investigators

found a 41.1 percent prevalence of pelvic organ prolapse
at a standard physical assessment in postmenopausal
women older than 60 years who had not had
hysterectomy
Swift et al found that over 50% of asymptomatic women
presenting for annual gynecologic examination have at
least stage 2 prolapse on examination.

Swift SE. The distribution of pelvic organ support in a population of female subjects seen for routine
gynecologic health care. Am J Obstet Gynecol. 2000 Aug. 183 (2):277-85
 Staging

The five stages of prolapse

Stage 0 No prolapse
Stage I The most distal portion of the prolapse
is >1 cm above the level of the hymen
Stage II The most distal portion of the prolapse
is 1cm proximal or distal to the
hymen
Stage III The most distal portion of the prolapse
is >1 cm below the hymen but
protrudes no further than 2 cm less
than the total length of the vagina
Stage IV Complete eversion of the vagina

ACOG Committee on Practice BulletinsGynecology. ACOG Practice Bulletin No. 85: Pelvic organ
prolapse. Obstet Gynecol. 2007;110(3):717729
 Risk Factor
Risk factor prolapse
Demographics Age
Postmenopausal status
Obstetric factors Parity
Vaginal delivery
Instrumental vaginal delivery
Pelvic surgery Pelvic organ prolapse surgery
Colposuspension
Rectopexy
Bowel dysfunction Chronic constipation
Defecatory straining
Connective tissue disorders Ehlers-Danlos/Benign joint
hypermobility syndrome
Marfan syndrome
Lifestyle factors Ehlers-Danlos/Benign joint
hypermobility syndrome
Marfan syndrome
Genetics Family history
White Caucasian, Asian race

Gyhagen M, Bullarbo M, Nielsen TF, Milsom I: Prevalence and risk factors for pelvic organ prolapse 20
years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean
delivery. BJOG 2013, 120:152-60.
Barber MD. Contemporary views on female pelvic anatomy. Cleve
Clin J Med 2005;72(suppl 4):S3-11.
 Signs and Symptoms
Signs and Symptoms
Vaginal Symptoms Sensation of a bulge or protrusion
Seeing or feeling a bulge
Pressure
Heaviness
Urinary symptoms Incontinence, frequency, or urgency
Weak or prolonged urinary stream
Feeling of incomplete emptying
Manual reduction of prolapse needed to start or
complete voiding (digitation)
Change of position needed to start or complete
voiding
Bowel Symptoms Incontinence of flatus, or liquid or solid stool
Feeling of incomplete emptying
Straining during defecation
Digital evacuation needed to complete defecation
Splinting (pushing on or around the vagina or
perineum)
needed to start or complete defecation (digitation)
Sexual symptoms Dyspareunia (painful or difficult intercourse)
Lack of sensation

Doshani A, Teo R, Mayne C, Tincello G. Uterine prolapse. BMJ 2007;335:819-23

 Treatment

Observation
Pelvic Floor Muscle Training
Pessaries
Surgical

Doshani A, Teo R, Mayne C, Tincello G. Uterine prolapse. BMJ 2007;335:819-23

Key points for fitting pessaries and their subsequent management
Fitting Ensure that the patients bladder and bowel
are empty
The pessary fits well if a finger can be swept
between the pessary and the walls of the
vagina
The goal is to fit the largest pessary that
does not cause discomfort
Ask the patient to walk around, bend, and
micturate to ensure that the pessary is
retained
Mana No consensus exists on how frequently to
geme see a patient after a pessary is fitted
nt
successfully
At each follow-up visit ask the patient about
any new symptoms and inspect for erosions,
ulcers, or discharge
Fitting a pessary can unmask symptoms of
urinary Incontinence

Kuncharapu I, Majeroni B, Johnson D. Pelvic organ prolapse. Am Fam

Physician. 2010;81(9):1111-1117, 1119-1120