POP-Q systems

Pelvic Organ Prolapse Quantification

System
Objective, site-specific system for describing and
staging POP
Involves a set of quantitative measurements of various
points representing anterior, apical and posterior
vaginal prolapse to create a topographic map of the
vagina.

Pelvic Organ Prolapse

Bladder, Urethra, Uterus, Vagina, Small bowel, Rectum
WHY? Risk Factors

 Pressure against the vaginal wall

Fullness in lower belly
Sense of something falling out of the vagina
Incontinence
Pain, Bleeding
constipation

Anterior vaginal wall points:

PointAais located in the midline of the anterior vaginal wall, 3 cm
proximal to the external urethral meatus, corresponding approximately
to the urethrovesical junction. The quantitative value of point Aa is
anywhere from 3 to +3 cm from the hymenal plane, depending upon
the extent of anterior wall prolapse.
PointBais the most distal (ie, most dependent) position of any part of
the anterior vaginal wall between point Aa and the vaginal cuff or
anterior vaginal fornix. If there is no prolapse, point Ba is 3 cm by
definition. The quantitative value of point Ba can range from the most
supported measurement [-3], to the most prolapse portion beyond the
hymenal ring [this may exceed +3 cm].

Superior vagina points:

PointCis the most distal (ie, most dependent) edge of the
cervix or the leading edge of the vaginal cuff (posthysterectomy).
PointDis measured only in women with a cervix. It is the
deepest point of the posterior fornix, corresponding
approximately to where the uterosacral ligaments attach to the
posterior cervix.
If point C is significantly more positive than point D (>4 cm), the
cervix is elongated.

 Posterior vaginal wall points :

PointApis located in the midline of the posterior vaginal wall, 3
cm proximal to the posterior hymen. The quantitative value of point
Ap is anywhere from 3 to +3 cm from the hymenal plane,
depending upon the extent of posterior wall prolapse.
PointBpis the most distal (ie, most dependent) position of any
part of the upper posterior vaginal wall between point Ap and the
vaginal cuff or posterior vaginal fornix. If there is no prolapse, point
Bp is 3 cm by definition. The quantitative value of point Bp can
range from the most supported measurement [-3], to the most
prolapse portion beyond the hymenal ring [this may exceed +3 cm].

 TVL : total vaginal length

The genital hiatus (gh) is measured anterior-posteriorly
from the middle of the external urethral meatus to the
posterior midline hymen. If the location of the hymen is
obscured by a band of skin (usually from surgery or
episiotomy repair), the firm tissue of the perineal body
is the posterior margin of this measurement.
The perineal body (pb) is measured from the posterior
margin of the genital hiatus to the midanal opening.

POINT

DESCRIPTION

RANGE

Aa

Anterior vaginal wall 3 cm

proximal to the hymen

-3 cm to +3 cm

Ba

Most distal position of the

remaining upper anterior
vaginal wall

-3 cm to + tvl

Most distal edge of cervix or

vaginal cuff scar

Posterior fornix (N/A if posthysterectomy)

Ap

Posterior vaginal wall 3 cm

proximal to the hymen

-3 cm to +3 cm

Bp

Most distal position of the

remaining upper posterior
vaginal wall

-3 cm to + tvl

Stage 0

No prolapse
Aa, Ba, Ap, Bp are -3 cm and C or D -(tvl 2) cm

Stage 1

Most distal portion of the prolapse -1 cm

(above the level of hymen)

Stage 2

Most distal portion of the prolapse -1 cm

but +1 cm (1 cm above or below the
hymen)

Stage 3

Most distal portion of the prolapse > +1 cm

but < +(tvl - 2) cm (beyond the hymen;
protrudes no farther than 2 cm less than the
total vaginal length)

Stage 4

Complete eversion; most distal portion of

the prolapse + (tvl - 2) cm

 Uterine prolapse
Anterior wall prolapse
Posterior wall prolapse
Vaginal vault prolapse
Enterocele