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Procidentia in pregnancy: a systematic review and recommendations for practice

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Abstract

Introduction and hypothesis

Pelvic organ prolapse (POP) in pregnancy is a rare condition with decreasing incidence and improved management and outcome world-wide recently. Systematic review of the literature for cases of POP in pregnancy published since 1990 was carried out to identify common factors in presentation, management and outcomes. One case from our own practice was added to the analysis.

Methods

An extensive search of the Pubmed/Medline, Scopus and Google Scholar databases was performed to identify all cases of POP in pregnancy since 1990. Published case reports of POP in pregnancy were reviewed and summarized in tables to find similarities in history, course, management and outcome of the pregnancies.

Results

Of the 43 cases and one case series, 41 case studies were eligible for analysis. Two types of POP in pregnancy were identified: preexisting is less common (14 vs 27 cases), often resolves during pregnancy (5 out of 14) and always recurs after delivery (14 out of 14); acute onset of POP in pregnancy rarely resolves in pregnancy (2 out of 27), but often resolves after delivery (18 out of 27). Most patients were managed with bed rest (20 out of 41), pessary (15 out of 41), manual reduction (6 out of 41) and local treatment (6 out of 41). The most common complications reported include preterm labour (14 out of 41), cervical ulcerations (9 out of 41), infection (3 out of 41) and obstructed labour (4 out of 41). About a half of the women delivered vaginally (22 out of 41), caesarean section due to prolapse was required in 15 cases.

Conclusions

Two distinct entities were identified based on similarities regarding onset, course and outcome of POP in pregnancy. Concise recommendations for practice were derived from the analysis of case studies published since 1990.

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Acknowledgements

The stay of the first author in Plymouth Hospitals NHS Trust, UK, was supported by the Faculty of Medicine in Pilsen, Charles University in Prague.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine in Pilsen, Charles University in Prague, Alej Svobody 80, Pilsen, 30460, Czech Republic

    Zdenek Rusavy

  2. Urogynaecology Unit, Women’s and Children’s Directorate, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK

    L. Bombieri & R. M. Freeman

Authors
  1. Zdenek Rusavy
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  2. L. Bombieri
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  3. R. M. Freeman
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Correspondence to Zdenek Rusavy.

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Rusavy, Z., Bombieri, L. & Freeman, R.M. Procidentia in pregnancy: a systematic review and recommendations for practice. Int Urogynecol J 26, 1103–1109 (2015). https://doi.org/10.1007/s00192-014-2595-3

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  • DOI: https://doi.org/10.1007/s00192-014-2595-3

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