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Genital prolapse
Clinical features Click to edit Master subtitle style MERLIN ASHLY M.S 2 ND YR MSc NSG
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ETIOLOGY
Congenital 2.
Acquired
Vaginal
delivery with consequent injury to supporting structures. The injury may be caused by over stretching of utero sacral ligaments bearing down efforts prior to
Premature
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Cont.
Prolonged Downward
2 nd stage of labour
Precipitate
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prolapse
Anterior wall prolapse of upper and descent of upper two third of anterior vaginal wall of bladder base through lax anterior wall
- cystocele
.Laxity
.Herniation
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Cont
-
urethrocele
Laxity May b.
of lower third of vaginal wall, urethra herniate through it occur along with cystocele called cysto urethrocele posterior wall perineum
-relaxed Torn
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Cont
-
rectocele
Laxity
of middle third of posterior vaginal wall and recto vaginal septum of rectum through lax area
Herniation
3. Vault prolapse
-
Enterocele Laxity of upper third of posterior vaginal wall Herniation of pouch of douglas with
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cont,
-
Occur 4.
following vaginal or abdominal hysterectomy uterine prolapse vaginal prolapse-prolapse of uterus, cervix and upper vagina can also occur congenitally when there is weakness of supporting structures holding uterus in position
-utero It
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degree-uterus starts descending down but external os remains inside vagina nd degree-external os protrudes out side vaginal interoitus , uterine body remains inside rd degree( procidentia/complete prolapse)- uterine body lies out side interoitus
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3 4
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Morbid changes
Vaginal mucosa stretched if exposed to air becomes thickened dry and surface keratinization ulcer
-Becomes -
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Cont..
In -
becomes elongated
In
-hypertrophy
and incomplete emptying of bladder due to sharp angulation of urethra against pubo urethral ligament ureteric changes will take place
Ureters -hydro
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symptoms
Feeling Back
of something coming down from vagina ache dragging pain in the pelvis symptoms in pasing urine
Dyspareunia Urinary
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Cont.
Painful Stress
Urinary Bowel
symptoms
-difficulty
-excessive
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Diagnostic measures
Pelvic
examination in dorsal and standing position ased to perform valsalva manuever through out examination bulge of anterior vaginal wall when the pateint is asked to strain
Patient
Cystocele
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Cont
Recto
2nd or 3 rd degree prolapse inspection reveals a mass protruding out through interoitus the 1 st degree prolapse cervical descent below the level of ischial spines
In
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Management of prolapse
Surgical 1.
management
-to
Excising
a portion of relaxed anterior vaginal wall bladder and push it upwards after cutting vesico cervical ligament plicating endo pelvic fascia and pubo cervical fascia
-mobilize -
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Cont
2.
perineorrhaphy
to repair posterior vaginal wall , involves of torn perineal body para rectal fascia
-repair
-tightening 3.
repair of entero cele and vault prolapse of neck of enterocele sac by purse string suture
-obliteration
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Cont
4.
Anterior 5.
colporrhaphy and colpo perineorrhaphy Fother gills operatio of cervix and amputation
-dialatation -plication -
of Mackerndots ligament raising cervix in to its place Anterior colporrhaphy and colpo perineorrhaphy
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Preventive measures
Adequate
ante natal and intranatal care-to avoid injury to supporting structures post natal care to avoid future pregnancies too management
Adequate Instruct
soon
Conservative 1. 2.
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VAULT PROLAPSE
MANAGEMENT 1. CONSERVATIVE TREMENT
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Cont
3. Le fort operation done uder loacal anaesthesia Colpocliesis Sarcospinous colpoplexy Abdominal approach cervico pexy done in congenital nulliparous
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DEFINITION
Inversion
is a condition where the uterus become turned inside out and fundus prolapsing cervix obstetric version sub
Causes Incomplete
mucosa
Sacromatous Senile
changes of fundus , fundal pressures alsp passed away inversion due to cervical
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clinical
Incomplete-
cervix
Complete-
inverted
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Clinical features
Symptoms Sensation Irregular
vaginal bleeding
Protruding
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Diagnostic measures
1.
Incomplete
hgh up
Cup 2.
rectal examination
Sound -using
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Treament
Anaemia
Conseervative Cutting
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Thank you
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