Sebastian Sarah, Jenkins Nicole, Pistilli Stephanie
Department of Obstetrics and Gynecology, Jersey Shore University Medical Center, Neptune City, NJ, United States.
Case Rep Womens Health. 2025 Jun 17;47:e00726. doi: 10.1016/j.crwh.2025.e00726. eCollection 2025 Oct.
Pelvic organ prolapse (POP) during pregnancy is rare, with few cases to guide clinical management. Vaginal delivery is possible; however, it is associated with increased risk of antepartum and intrapartum complications. This report discusses a case of intrapartum severe uterine prolapse in pregnancy and management techniques which resulted in a successful vaginal delivery. A 43-year-old grand multiparous woman (para 9) presented at 40 weeks in labor with stage III uterine prolapse. She had been diagnosed during her antepartum course, but declined a pessary and opted instead for expectant management. Her labor course was complicated by obstructed labor until she underwent manual reduction of her prolapse, subsequent bedrest, and oxytocin augmentation, leading to vaginal delivery of a term neonate. Her third stage was complicated by uterine atony, managed with bimanual massage and uterotonics. This case illustrates that vaginal delivery is feasible in pregnancies complicated by severe uterine prolapse when pelvic anatomy is appropriately restored. Restoration may facilitate labor progression and reduce the risk of obstructed labor. However, the risk of intrapartum complications remains high. Awareness of these potential complications is critical as impaired uterine contractility from uterine prolapse may limit effective labor mechanics in all stages of labor.
妊娠期盆腔器官脱垂（POP）较为罕见，可供指导临床管理的病例很少。阴道分娩是可行的；然而，它与产前和产时并发症风险增加有关。本报告讨论了一例妊娠期产时严重子宫脱垂病例及成功实现阴道分娩的管理技术。一名43岁的经产妇（孕9产）在孕40周时临产，患有Ⅲ度子宫脱垂。她在产前检查时被诊断出，但拒绝使用子宫托，而是选择了期待治疗。她的产程因产程梗阻而复杂化，直到她接受了脱垂手动复位、随后卧床休息以及缩宫素加强宫缩，最终阴道分娩出一名足月儿。她的第三产程因子宫收缩乏力而复杂化，通过双手按摩和宫缩剂进行处理。该病例表明，当盆腔解剖结构得到适当恢复时，妊娠期合并严重子宫脱垂的情况下阴道分娩是可行的。解剖结构的恢复可能有助于产程进展并降低产程梗阻的风险。然而，产时并发症的风险仍然很高。认识到这些潜在并发症至关重要，因为子宫脱垂导致的子宫收缩力受损可能会限制分娩各阶段有效的产程机制。
