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Friday, December 18, 2020

Uterine prolapse: Management, Complications, Nursing management&Intervention

 Uterine Prolapse 

Uterine prolapse is an abnormal position of the uterus in which the uterus protrudes downward. 

Pathophysiology and Etiology 

  • Uterus herniates through pelvic floor and protrudes into vagina (prolapse ) and possibly beyond the introitus (procidentia). 
  • Usually caused by obstetric trauma and overstretching of musculofascial supports 
  • Degree 
    • First degree- cervix prolapses into vaginal canal.
    • Second degree- cervix is at the introitus.
    • Third degree - cervix extends over the perineum.
    • Marked procidentia - the entire uterus protrudes outside vaginal cavity.
    • The pelvic organ prolapse quantified system may be used to evaluate prolapse

Clinical Manifestations 

  • Backache or abnormal pain.
  • Pressure and heaviness in vaginal region. 
  • Bloody discharge because of cervix rubbing against clothing or inner thighs. 
  • Ulceration of cervix. 
  • Symptoms are aggravated by obesity, standing, straining, coughing, or lifting a heavy object because of increased intra-abdominal pressure.
Diagnostic Evaluation 

Pelvic examination identifies conditions 


  • Hysterectomy or surgical correction 
  • Vaginal pessary  - plastic device inserted into vagina as temporary or palliative measure if surgery cannot be done.
  • Estrogen cream - to decrease genital atrophy 
  • Necrosis of cervix, uterus.
  • Infection. 
Nursing Assessment 
  • Obtain history of childbirth and surgery. 
  • Ask about symptoms and aggravating factors.
  • Examine patient in lying or standing position; if cervix not readily visible, spread labia gently, do not attempt to insert speculum.
Nursing Diagnosis 
  • Acute pain related to downward pressure and exposed tissue. 
  • Impaired tissue integrity related to exposed cervix and uterus. 
  • Sexual dysfunction related to loss of vaginal cavity.
Nursing Intervention 

Relieving pain
  • Administer sitz bath and explain procedure to patient. 
  • Provide heating pad for lower back or lower abdomen. 
  • Administer pain medications as ordered. 
  • Check for proper placement of pessary. 
  • Increase fluid intake and encourage patient to void frequently to prevent bladder infection. 
Maintaining cervical and uterine mucosal integrity 
  • For second, and third-degree prolapse, apply saline compresses frequently. 
  • Provide postoperative care
    • Administer perineal care to patient after each voiding and defecation.
    • If urinary retention occurs, catheterize or use indwelling catheter until bladder tone is regained
    • Apply an ice pack locally to relive congestion
    • Promote ambulation but prevent straining to reduce pelvic pressure. 
Restoring sexual function 
  • Discuss with patient noncoital sexual activity before treatment is instituted.
  • Explain to patient that sexual intercourse is possible with pessary; however, vaginal canal may be shortened. 
  • Reinforce surgeon's instructions postoperatively about waiting to have vaginal penetration.
  • Encourage patient to explore with partner ways to engage in sexual activity without strain with greatest comfort.

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