Question

Write the management of a 32-year-old P2 presenting with third-degree cervical descent.

Hint:

The management of prolapse depends on the severity, symptoms, and patient preference. Surgical options are recommended for significant prolapse, while conservative management can be a trial for those with mild symptoms.

Answer 1

Step 1: Introduction.
A 32-year-old woman, P2 (parity 2), presenting with third-degree cervical descent indicates a significant pelvic organ prolapse (POP). In this case, the cervix has descended past the hymenal ring but has not fully prolapsed. The management approach should aim at relieving symptoms and preventing further descent.
Step 2: Conservative Management.
In cases of mild to moderate symptoms or in women who wish to delay surgery, conservative management options include:
(1) Pessary Use - A vaginal pessary can provide support for the prolapsed organs and prevent further descent. This is often recommended for women who do not want immediate surgery or are poor surgical candidates.
(2) Pelvic Floor Exercises - Kegel exercises to strengthen the pelvic floor muscles and provide support to the pelvic organs.
Step 3: Surgical Management.
For a third-degree cervical descent, especially if conservative methods fail, surgery is typically recommended. Options include:
(1) Vaginal Hysterectomy with Pelvic Floor Repair - Removal of the uterus (if desired by the patient) along with repair of the pelvic floor to correct the prolapse.
(2) Uterine Suspension (if uterus is preserve - Suspension of the uterus to restore its normal position.
(3) Colpocleisis - A procedure that is an option for older women or those with limited sexual activity, where the vaginal canal is closed, offering relief from prolapse.
Step 4: Postoperative Care.
Post-surgery, women should follow a rehabilitation plan involving pelvic floor exercises to strengthen the muscles and prevent recurrence of prolapse.