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Is cervical elongation associated with pelvic organ prolapse?

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Abstract

Introduction and hypothesis

It is commonly believed that pelvic organ prolapse (POP) is associated with cervical elongation. However, cervical lengths have not been formally compared between women with prolapse and those with normal support.

Methods

Cervix and uterine corpus lengths were measured on magnetic resonance images in a case-control study of 51 women with prolapse and 46 women with normal support determined by the Pelvic Organ Prolapse Quantification (POP-Q) examination. Group matching ensured similar demographics in both groups. Ranges for normal cervical lengths were determined from the values in the control group in order to evaluate for cervical elongation amongst women with prolapse.

Results

The cervix is 36.4 % (8.6 mm) longer in women with prolapse than in women with normal pelvic support (p < 0.001). Linear regression modeling suggests the feature most highly associated with cervical length is the degree of uterine descent (POP-Q point C). Approximately 40 % of women with prolapse have cervical elongation; 57 % of cervical elongation in prolapse can be explained by a logistic regression-based model including POP-Q point C, body mass index, and menopausal status.

Conclusions

Cervical elongation is found in one third of women with POP, with the extent of elongation increasing with greater degrees of uterine descent.

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Acknowledgments

We gratefully acknowledge funding support from NICHD through grant R01 HD 38665 and ORWH through grant P50 HD44406. We thank Mark D. Pearlman, M.D., for critical reading of the manuscript. Preliminary data from this study were presented as a poster at the American Urogynecologic Society 31st Annual Scientific Meeting in Long Beach, CA (September, 2010).

Conflicts of interest

J. O. L. DeLancey receives research support from American Medical Systems, Johnson & Johnson and Kimberly Clark. The authors have no other relevant disclosures.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA

    Mitchell B. Berger & John O. L. DeLancey

  2. Gynecologic Surgery, Besançon University Medical Centre, Besançon, France

    Rajeev Ramanah

  3. Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA

    Kenneth E. Guire

  4. Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA

    Mitchell B. Berger, Kenneth E. Guire & John O. L. DeLancey

  5. L4000 Women’s Hospital, 1500 E. Medical Center Drive, SPC 5276, Ann Arbor, MI, 48109-5276, USA

    Mitchell B. Berger

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  1. Mitchell B. Berger
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  2. Rajeev Ramanah
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  3. Kenneth E. Guire
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  4. John O. L. DeLancey
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Correspondence to Mitchell B. Berger.

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Berger, M.B., Ramanah, R., Guire, K.E. et al. Is cervical elongation associated with pelvic organ prolapse?. Int Urogynecol J 23, 1095–1103 (2012). https://doi.org/10.1007/s00192-012-1747-6

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  • DOI: https://doi.org/10.1007/s00192-012-1747-6

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