gynecology and obstetrics
Uterine and Apical Prolapse
Introduction
Uterine prolapseis descent of the uterus toward or past the introitus.Apical prolapseis descent of the vaginal vault or vaginal cuff after hysterectomy. Symptoms include vaginal pressure and fullness. Diagnosis is clinical. Treatment includes reduction, pessaries, and surgery. Severityof vaginal wall prolapse can be graded by the Pelvic Organ Prolapse-Quantification (POP-Q) system: Stage 0: No prolapse Stage I: Most distal prolapse is more than 1 cm above the hymen Stage II: Most distal prolapse is between 1 cm above and 1 cm below the hymen Stage III: Most distal prolapse is more than 1 cm below hymen but 2 cm shorter than total vaginal length Stage IV: Complete eversion The POP-Q system is recommended by professional organizations because it is a reliable and reproducible classification system that is based on predefined anatomic landmarks. The Baden-Walker system, which is based on level of protrusion, is sometimes used. However, it is an older classification system that is not reproducible: Grade 0: No prolapse Grade 1: Halfway to the hymen Grade 2 : To the hymen Grade 3 : Halfway past the hymen Grade 4: Maximal possible 