Raya Strauss Wing, Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel, Nazareth Hospital EMMS, Nazareth, Israel.
Isr Med Assoc J. 2024 Sep;26(8):493-499.
Pelvic organ prolapse in pregnancy is rare. Consequent complications include cervical infection, spontaneous abortion, and premature birth. Conservative management by means of a pessary have been described as improving maternal symptomatology and minimizing gestational risk. The delivery mode is controversial.
To describe the clinical courses of patients diagnosed with pelvic organ prolapse during pregnancy, and to present our multidisciplinary approach.
In this retrospective case series, we summarized the obstetrical outcomes of women diagnosed with pelvic organ prolapse during pregnancy in a single university-affiliated hospital.
We identified eight women with advanced uterine prolapse at a mean age of 30.3 years. Seven were diagnosed with advanced uterine prolapse (Pelvic Organ Prolapse Quantification [POPQ] stage ≥ 3). All were treated by pessary placement, which was tolerable and provided symptomatic relief. The pessary type was chosen according to the prolapse stage. In women with cervical prolapse POPQ stage > 2 and cervical edema, a support pessary was less beneficial. However, the prolapse was well-controlled with a space-filling Gellhorn pessary. Low complication rates were associated with vaginal deliveries. The few complications that were reported included minor cervical laceration, postpartum hemorrhage, and retained placenta.
Treatment of pelvic organ prolapse during pregnancy must be individualized and requires a multidisciplinary approach of urogynecologists, obstetricians, dietitians, pelvic floor physiotherapists, and social workers. Conservative management, consisting of insertion of a vaginal pessary when prolapse symptoms appeared, provided adequate support for the pelvic floor, improved symptomatology, and minimized pregnancy complications. Vaginal delivery was feasible for most of the women.
妊娠合并盆腔器官脱垂较为罕见。随之而来的并发症包括宫颈感染、自然流产和早产。通过放置子宫托进行保守治疗可以改善产妇的症状并降低妊娠风险。分娩方式存在争议。
描述妊娠合并盆腔器官脱垂患者的临床经过，并介绍我们的多学科治疗方法。
本回顾性病例系列研究总结了单所大学附属医院妊娠合并盆腔器官脱垂患者的产科结局。
我们共纳入 8 例年龄 30.3 岁的重度子宫脱垂孕妇。7 例诊断为重度子宫脱垂（盆腔器官脱垂定量 [POPQ] 分期≥3 期）。所有患者均接受子宫托治疗，能够耐受且症状缓解。根据脱垂分期选择子宫托类型。对于宫颈脱垂 POPQ 分期>2 且宫颈水肿的患者，支撑型子宫托效果不佳，而 Gellhorn 型子宫托可良好控制脱垂。阴道分娩与低并发症发生率相关。少数患者出现宫颈裂伤、产后出血和胎盘滞留等并发症。
妊娠合并盆腔器官脱垂的治疗必须个体化，需要妇产科医生、营养师、盆底物理治疗师和社会工作者等多学科团队共同参与。当脱垂症状出现时，通过阴道放置子宫托进行保守治疗可以为盆底提供充分的支持，改善症状并降低妊娠并发症的风险。对于大多数患者，阴道分娩是可行的。
