Pregnant Prolapse
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Presentation of uterine prolapse is a rare event in a pregnant woman, which can be pre-existent or else manifest in the course of pregnancy. Complications resulting from prolapse of the uterus in pregnancy vary from minor cervical infection to spontaneous abortion, and include preterm labor and maternal and fetal mortality as well as acute urinary retention and urinary tract infection. Moreover, affected women may be at particular risk of dystocia during labor that could necessitate emergency intervention for delivery. Recommendations regarding the management of this infrequent but potentially harmful condition are scarce and outdated. This review will examine the causative factors of uterine prolapse and the antepartum, intrapartum and puerperal complications that may arise from this condition as well as therapeutic options available to the obstetrician. While early recognition and appropriate prenatal management of uterine prolapse during pregnancy is imperative, implementation of conservative treatment modalities throughout pregnancy, these applied in accordance with the severity of the uterus prolapse and the patient's preference, may be sufficient to achieve uneventful pregnancy and normal, spontaneous delivery.
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Karamercan A, Tatlicioglu E, Ferahkose Z.
Karamercan A, et al.
J Reprod Med. 2007 Jun;52(6):545-7.
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Ozel B.
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Sakaguchi D, Ishida H, Yamada H, Tsuzuki S, Hayashi Y, Yokoyama M, Hashimoto D.
Sakaguchi D, et al.
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Parker JD, Broberg JC, Napolitano PG.
Parker JD, et al.
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Wu JS, Fazio VW.
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Background:
Rectal prolapse is a bothersome surgical problem that is relatively infrequent. It usually occurs in the fifth to seventh decades of life and is more common in women.
Case:
A 33-year-old woman, gravida 3, para 2, was found to have a large rectal prolapse at 33 weeks' gestation. Manual reduction was successfully performed after injecting 2% lidocaine into and around the anal sphincter. Because she could not undergo definitive surgical repair during her pregnancy, the patient was managed with an aggressive stool softening regimen and self-reduction techniques. Labor was induced in the 40th gestational week. Epidural anesthesia was employed, and delivery was accomplished via low-outlet forceps application. The patient underwent definitive surgical repair of the rectal prolapse eight weeks postpartum.
Conclusion:
Rectal prolapse is a rare condition during the childbearing years. We found no prior case reports of rectal prolapse occurring during pregnancy. While childbirth itself is not considered a risk factor for rectal prolapse, a prior history of perineal lacerations may be a risk factor. To manage rectal prolapse that occurs during pregnancy, consideration should be given to passive forceps delivery under epidural anesthesia to avoid the possibility of worsening the prolapse.
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https://pubmed.ncbi.nlm.nih.gov/23692627/
https://pubmed.ncbi.nlm.nih.gov/10664948/
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