uterine prolapse

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IT INCLUDES DEGREES OF UTERINE PROLAPSE,SIGNS AND SYMPTOMS, DIAGNOSIS & MANAGEMENT

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UTERINE PROLAPSE:

UTERINE PROLAPSE Presented B y: MISS. Sumitra ghutiya, 3 rd year GNM, SVBCON, SILVASSA. 10/10/2015 1 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

Uterine prolapse:

Uterine prolapse 10/10/2015 2 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

Description:

Description Uterine prolapse occurs when pelvic floor muscles & ligaments stretch & weaken providing inadequate support for the uterus . The uterus then descends in to the vaginal canal , uterine prolapse usually happen in women who have had one or more vaginal births , conginital or nulliparous prolapse is a rare types of prolapse seen in young women . 10/10/2015 3 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

Definition:

Definition Prolapse of uterus reffers to a collapse, descent or change in the position of the uterus in relation to surrounding structures in the pelvis. 10/10/2015 4 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

Associated conditions:

Associated conditions Cystocele Urethrocele Enterocele Rectocele Relexed perineum 10/10/2015 5 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

CYSTOCELE :

CYSTOCELE 10/10/2015 6 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

URETHROCELE :

URETHROCELE 10/10/2015 7 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

ENTEROCELE :

ENTEROCELE 10/10/2015 8 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

RECTOCELE :

RECTOCELE 10/10/2015 9 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

Degrees of prolapse:

Degrees of prolapse First stages : The uterus sags down ward from the normal anatomic position into the upper vagina . The external os remains inside the vagina . Second degree : the cervix is at or out side the vagina introitus , but the uterine body remains inside the vagina . 10/10/2015 10 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

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Third degree : This types is also referred to as complete prolapse or perocidentia . The entire uterus decends to lie outside the interoitus. 10/10/2015 11 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

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10/10/2015 12 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

CAUSES:

CAUSES Stretching of the pelvic support system. Pelvic relaxation that happens during pregnancy . Chronic increased in intra – abdominal pressure . Normal aging & lack of estrogen hormone after menopause . 10/10/2015 13 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

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10/10/2015 14 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

SYMPTOMS:

SYMPTOMS A felling of some thing coming down per vagina especially while moving about there may be variable discomfort on walking when the mass come out of the interoitus . Backache Dyspareunia URINARY SYMPTOMS Difficulty in passing urine Incomplete emptiying of bladder Urgency &frequency of micturation due to cystitis . 10/10/2015 15 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

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Stress incontinence usally due to associated urethrocele . Retention of urine may rarely occurs . BOWEL SYMPTOMS (in presence of rectocele ): Difficulty in passing stool Excessive white or blood stained discharge per vagina due to associated vaginitis or ulceration. 10/10/2015 16 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

Examination & Diagnosis :

Examination & Diagnosis Inspection & palpation : vagina , rectal , & rectovaginal examination . Pelvic examination : in dorsal & standing position patient may be asked to perform valsalva maneuver during examination . Examination in squating position if reconfirmation is required . Examination under anesthesia if difficult to arrive at a conclusion . 10/10/2015 17 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

Management of uterine prolapse:

Management of uterine prolapse CONSERVATIVE Estrogen replacement theraphy may improve minor degree prolapse in post manopausal women . In mild cases exercise to strenthen pelvic floor muscles may help . Obese pt may be instructed to reduce wight in order to reduce pressure on pelvic organ . 10/10/2015 18 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

NON SURGICAL MANAGEMENT:

NON SURGICAL MANAGEMENT Pessary may be placed inside the vagina to support the pelvic organs for patient who do not desire for surgery . This serves to relive the symptoms but does not cure the condition . Pessary may also be used for patients waiting for surgery or unfit for surgery . 10/10/2015 19 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

SURGICAL MANAGEMENT:

SURGICAL MANAGEMENT Surgical management depends upon the anatomical altration of structures & the degree of prolapse . Pt age & reproductive & sexual function are also considerd. Anterior colorrhaphy for correction of cystocele & urethrocele . Perinorrhaphy /colopoperinerrhaphy to repair the prolapse of posterior vaginal wall which may include repair of relaxed perineum , rectocele & enterocele . 10/10/2015 20 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

Fothergill’s or manachester operation:

Fothergill’s or manachester operation This is designed to correct uterine desend associated with cystocele & uterine is desired . The operation combines repair of anterior & operation vaginal wall with amputation of cervix . Vaginal hysterectomy with pelvic floor repair . TAH (total abdominal hysterectomy ) 10/10/2015 21 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

Vaginal hysterectomy:

Vaginal hysterectomy 10/10/2015 22 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

TAH (total abdominal hysterectomy ) :

TAH (total abdominal hysterectomy ) 10/10/2015 23 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

PREVENTIVE MANAGEMENT:

PREVENTIVE MANAGEMENT Adequate antenatal & intranatal care . Adequate postnatal care . Genaral measures . 10/10/2015 24 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

COMPLICATION:

COMPLICATION IMMEDIATE: Retention of urine Infection leading to cystitis Wound seosis 10/10/2015 25 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

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LATE Dyspureunia Recurrence of prolapse UVF: following bladder injury . RVF : following rectal injury. Cervical stenosis : hemometru . Infertility . Cervical incompentency . 10/10/2015 26 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

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10/10/2015 27 SHRI VINOBA BHAVE COLLEGE OF NURSING, SILVASSA, D&NH

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