1)) Prolapse Uterus

2)) DUB
3
3)) Fibroid uterus

GYNECOLGY 4)) Ovarian mass

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 Prolapse yrs – N baby – After 1 yr
Not sterlized
Ananthamma/65/nizamabad/SEIV &
labourer 10 yrs back.
FAMILY H/O: Not significant
C/C:
PERSONAL H/O:
Mass per vaginum – 4 yrs
Diet: mixed, appetite: reduced
H/P/I: B/B: regular, Sleep: disturbed
Addictions: Non smoker & Non alcoholic & NON
Patient was apparently assymptomatic 4 yrs back
consangious marriage
then she noticed mass per veginum which is initially
lemon size gradually progressive to reach present GCOE:
size. Patient is C/C/C.
Reducable manually & increases in size on lifting Moderately built & with BMI ??
weights & coughing P (-) I (-) C (-) C (-) K (-) L (-)
H/O back ache initially for 1st 2 yrs which was Vitals – afebrile,
HR: 83/min. N in volume, character, & rhythm No
localized aggravated on standing & relived on
RR/RF delay No vessel wall thickening
sleeping Now there is No back ache BP: 160/90 mm hg RUL: Supine
H/O difficulty in micturition on straining RR: 18/min regular
H/O lifting weights for 30 yrs JVP: NOT raised
No H/O Chronic cough
No H/O any discharge PV LOCAL EXAMINATION
Perineal examination:
NO H/O wound on mass PV
Scanty pubic hair, gaping introitus,
NO H/O constipation Atrophic labia majora, Labia minora
NO H/O leaking of urine on coughing Not visible, Pink mass per vaginum with
NO H/O irreducibility episodes cervical lips seen
NO H/O fever with chills & rigor with burning On ant vaginal wall - Keratinization (3*3 cm) seen
micturition & vaginal mucosa – atrophic
No H/O frequency of micturition No urine passage with coughing
P/S: Enterocole & No rectocoele
PAST H/O: P/V: Uterus retroverted, Levator ani tone poor.
NO H/O HTN Puborectalis (at 4 & 8 o clock) – poor tone
NO H/O DM, TB, IHD, RHD, epilepsy, chest pain /
Jaundice & bleeding disorders SYSTEMIC EXAMINATION
CVS examination- S1 & S2 heard. No other murmers
MENSTRUAL H/O: heard
Reached menopause 10 yrs back
previous cycles - 4/28.. Respiratory Examination: BLAE +ve & N vesicular
3-4 pads / day sounds heard with No adventitious sounds
No H/O white discharge
No H/O clot passage Diagnosis: A 65 yr old post menopausal women
No H/o dysenorrhoea came with P3L3 with 3 degree uterine prolapse
with cystocoele & Enterocoele & also poor pelvic
OBSTETRIC H/O: P3L3 floor tone.
1st pregnancy – FTNVD – Male - Home – Local Dai –
45 yrs – N baby – After 1 yr
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2 nd pregnancy– FTNVD – Male - Home – Local Dai

– 43 yrs – N baby – After 2 yr
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3 rd pregnancy – FTNVD – female – Local Dai – 45

 symphisis & Highest Point on post vaginal
DISCUSSION: fornix.

Different classifications
1)) Shah’s classification
2)) Malpas Classification:
a)) UV prolapse:
ligament weakening
b)) Nulliparous / general:
Muscle weakening
3)) Jaffcoat’s Classification b)) Surgical: U2/3, L 1/3 with U1/3 (enterocoele)
4)) POP – Q Classification M1/3 (Rectocoele) L1/3 (perineal body prolapse)

POP – Q:The classification uses six points along the
vagina (two points on the anterior, middle &
posterior compartments) measured in relation to the
hymen.
The anatomic position of the six defined points
(Aa,Ba,C,D,Ap,Bp) should be measured in
centimeters proximal to the hymen (negative
number) or distal to the hymen (positive number),
with the plane of the hymen representing zero.
1)) UV prolapse:
Radical / Waldmeyer
[ >40, >35*]
conservative [Shirodkar’s surgery – No stenosis,
patulous & fothergill’s surgery – Stenosis, patulous]
2)) Nulliparous: Abd / Vaginal sling operations &
org (purandeswar’s – Lat sling) / Inorg (shirodkar’s –
Lat. & Khanna – Post)

Three other measurements include genital hiatus, Decubitus ulcer pathology:

perineal body, and the total vaginal length. - arterial kinking
Accordingly divided into stage 0 – stage IV - Venous congestion
- trauma
Treatment
a)) Non surgical (PFMT, pelvic floor muscle tone, Measurement of supravaginal portion of cervix:
Biofeedback in rectocoele & Pessary: Passing sound upto Internal os (resistance felt) –
minus Passing sound into lat fornix (difference gives
the length)

Pessaries Ovarian mass Uterine mass

Support and Space filling Usually cystic Usually firm / hard
1)) Ring pessary (with diaphragm) is
a commonly used support pessary, and R/L Midline
2)) Gelhorn pessary is a commonly used
space–filling pessary. Movable side to side & Movable side to side
also vertcally
** Support pessaries are recommended for
stage I and II prolapse {O,U,R,I pessaries}, Transmitted movements Transmitted movements
*** Space–filling pessaries are used for stage -ve +ve
III and IV prolapse {X,L,M,N,W,G,F}
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Cystocoele &/or rectocoele {J,I} Can feel all borders Lower border is usually
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Pessary measured – Bimanually: pubic

 not felt

Hingorin Sulcus present Absent

between ovarian mass
& uterus

Midline masses: adenomyosis, fibroids, pregnancy,

encysted acsitis, full bladder

Tendercervical movements: Endometriosis & PID

Frozen pelvis: TB, PID, Radiation, retroperitoneal

fibrosis, Invasive mole

Common diseases of reproductive age women:

Fibroids, endometriosis, PID

Dictum any uterus >12w: fibroid

If < 10w: fibroid / adenomyosis

Endometriosis & Adenomyosis: Triple

dysmenorrheal:- pain before, during & after
menstruation
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