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Uterine Prolapse During Pregnancy: Symptoms, Causes, Treatment, And Risks

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IN THIS ARTICLE

The uterus is held in its position within the pelvis by ligaments and muscles of the pelvic floor. However, when these ligaments and muscles are damaged, stretched, or weakened, the uterus may drop into the vagina leading to uterine prolapse (1).

Uterine prolapse during pregnancy is a rare condition with an occurrence of one case in every 10,000 to 15,000 deliveries (2). In this MomJunction, we provide information on the implications of uterine prolapse during pregnancy, its symptoms, risk factors, and more.

Does A Uterine Prolapse Affect Pregnancy?

A prolapsed uterus may cause the following complications (2)(3).

  • Preterm labor
  • Difficulty during labor
  • Cervical discomfort
  • Cervical desiccation and ulceration
  • Urinary tract infection
  • Acute urinary retention
  • Fetal and maternal sepsis
  • Postpartum hemorrhage

Complex cases of uterine prolapse may cause abortion of the fetus. Complications may occur even after childbirth (4). But do not panic since extreme complications and problems due to uterine prolapse usually occur when the condition is ignored. The symptoms of uterine prolapse seldom go unnoticed, and you are likely to feel it before the problem gets worse. 

Signs And Symptoms Of Uterine Prolapse During Pregnancy

Here are some of the common symptoms of uterine prolapse during pregnancy (5)(6).

  • A visible protrusion from the vagina
  • Sensation of a bulge in the vagina
  • Pelvic heaviness
  • Pressure, heaviness, and a dragging sensation in the vagina
  • Back pain
  • Urinary incontinence – the feeling of incomplete emptying
  • A feeling of incomplete emptying of the bowel

The symptoms of uterine prolapse are usually most noticeable during the third trimester. See a doctor when you notice or feel the symptoms.

Prolapse is unlikely to be present before pregnancy. If present, it may resolve during pregnancy but may reappear after childbirth (4).

Causes Of Uterine Or Cervical Prolapse During Pregnancy

Pelvic muscles may weaken due to several reasons and increase the chances of uterine prolapse. The following conditions and factors may increase the risk of developing uterine prolapse (2)(4)(7).

  1. Trauma to the pelvic muscles during vaginal childbirth may stretch and weaken the muscles. It increases the chances of developing uterine prolapse in subsequent pregnancies.
  1. Multiple pregnancies and multiple deliveries, like in the case of delivering twins or triplets.
  1. Delivering a large baby through vaginal birth.
  1. Subsequent pregnancies with short intervals could also make the uterus susceptible to prolapsing.
  1. Congenital connective tissue disorders could cause pelvic muscles and ligaments to remain weak, which increases the chances of uterine prolapse.
  1. Physiological changes of the uterus, ligaments, and muscles of the body during pregnancy. For instance, hormonal changes during pregnancy could cause relaxation of ligaments. It may increase the risk of uterine prolapse.
  1. Chronic intra-abdominal pressure due to persistent straining for bowel movement or repeated lifting of heavy weights.

Your doctor will determine the exact cause of uterine prolapse after performing diagnostic steps.

Diagnosing Uterine Or Cervical Prolapse During Pregnancy

Healthcare practitioners can diagnose the prolapse through pelvic examination. The doctor may ask the patient to perform a Valsalva maneuver, a breathing technique, which can help the doctor examine the full extent of the prolapse (8). The doctor may suggest an MRI of the pelvis to further confirm the diagnosis (9).

Treatment Of Uterine Or Cervical Prolapse During Pregnancy

The treatment approach depends on the stage of prolapse, the stage of pregnancy, and if the patient has any other complications. Your doctor may suggest the following treatment and care measures during pregnancy (10).

  1. Maintaining genital hygiene may help prevent the development of infections and other complications.
  2. The doctor may place a small device called pessary into the vagina to prevent the uterus from collapsing. The pessary is kept in place until the onset of labor.
  3. If other conservative treatment steps are ineffective, then the doctor may perform a laparoscopic uterine suspension where the uterus is surgically suspended back to its original position.

    If uterine prolapse persists even as you approach the due date, the doctor may consider performing a cesarean section to prevent complications.

Can You Prevent Uterine Prolapse During Pregnancy?

There is no particular way to prevent uterine prolapse. Observing certain precautions and making some changes in lifestyle may help reduce the risk of developing uterine prolapse. The following are the measures you may take to minimize the chances of developing uterine prolapse during pregnancy (9)(11).

  • Lose weight if you are overweight
  • Include fiber and fluids in your diet to avoid constipation or excessive straining
  • Avoid lifting heavy weights
  • Take medical advice in case you have chronic cough since it can strain pelvic organs and muscles
  • In mild cases, you may perform Kegel exercises to strengthen your pelvic floor muscles. Make sure to discuss with your healthcare practitioner or physiotherapist before performing any exercise during pregnancy.

 An existing uterine prolapse may resolve after childbirth, and there is also no risk to the baby after delivery.

Uterine prolapse may occur as a result of one factor or due to a combination of factors. It can be categorized into stages.

Stages Of Uterine Prolapse

Stages Of Uterine Prolapse

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There are different stages of uterine prolapse, depending on how far the uterus dropped into the vagina. The following are the four stages (5)(7).

  • Stage I: The uterus drops down to the upper half of the vagina. The most distal portion of the prolapse is >1cm above the level of the hymen.
  • Stage II: The uterus has dropped down nearly to the opening of the vagina. The most distal portion of the prolapse is ≤1cm proximal or distal to the hymen.
  • Stage III: The uterus protrudes out of the vagina.The most distal portion of the prolapse is >1cm below the hymen but protrudes no farther than 2cm less than the total length of the vagina.
  • Stage IV: The uterus is completely out of the vagina. There is a complete eversion of the vagina.

Can You Get Pregnant And Give Natural Birth With A Prolapsed Uterus?

Early diagnosis and proper management of the condition can lead to a safe pregnancy or gestation period (2). Various published case studies have reported successful natural birth with a prolapsed uterus (4)(6). However, there may be an increased risk to the fetus and the mother due to uterine prolapse. Seeking prompt treatment can help have a trouble-free delivery.

Uterine prolapse is rare during pregnancy. If the condition does occur, a routine gynecological examination by your healthcare provider can help in the timely diagnosis and management of the condition.

Have anything to share about uterine prolapse during pregnancy? Share your thoughts with us in the comment section below. 

References: 

1. Surgery for Pelvic Organ Prolapse: American College of Obstetricians and Gynecologists. (2018).
2. Buyükbayrak, E. E., Yılmazer, G., Ozyapı, A. G., Kars, B., Karşıdağ, A. Y., & Turan, C. Successful management of uterine prolapse during pregnancy with vaginal pessary: a case report: Journal of the Turkish German Gynecological Association, 11(2), 105–106. (2010).
3. Tsikouras, P., Dafopoulos, A., Vrachnis, N., Iliodromiti, Z., Bouchlariotou, S., Pinidis, P., … & Von Tempelhoff, G. F. Uterine prolapse in pregnancy: risk factors, complications and management: The Journal of Maternal-Fetal & Neonatal Medicine, 27(3), 297-302. (2014).
4. Zeng, C., Yang, F., Wu, C., Zhu, J., Guan, X., & Liu, J. Uterine Prolapse in Pregnancy: Two Cases Report and Literature Review: Case reports in obstetrics and gynecology, 2018. (2018).
5. Doshani, A., Teo, R. E., Mayne, C. J., & Tincello, D. G. Uterine prolapse: BMJ (Clinical research ed.), 335(7624), 819–823.  (2007).
6. De Vita, D., & Giordano, S. Two successful natural pregnancies in a patient with severe uterine prolapse: A case report. Journal of medical case reports, 5, 459. (2011).
7. Prolapsed uterus: Department of Health & Human Services, State Government of Victoria, Australia. (2017).
8. Pelvic Organ prolapse: American family Physician. (2010).
9. Uterine Prolapse: John Hopkins Medicine. (n.d.).
10. Latika, Nanda S, Chauhan M, Malhotra V. Pregnancy with third degree uterine prolapse-a rare case report.International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 5, 579-81. (2016).
11. What to do about pelvic organ prolapse: Harvard Health Publishing. (2014).
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