UTERINE DISPLACEMENT

DISPLACEMENT OF UTERUS

1. UTERINE PROLAPSE

2. uterine prolapse Prolapse of the uterus refers to the downward displacement of the vagina and uterus.

3. etiology

4. Predisposing factors 1.Congenital - At birth 2.Acquired – During Labour 1-Bearing down 2-Forceps delivery 3- Traction on cord 4 - Breech extraction before fully dilatation

5. Predisposing factors During puerperium Lack of exercise and bodily weakness Repeated deliveries or child birth

6. Aggravating factors 1. Increase in intra -abdominal pressure Abdominal mass Ascitis Chronic cough, constipation 2. Obesity 3. Uterine fibroid

7. DEGREEs of uterine prolapse 1.In first-degree prolapse - the prolapsed wall extends upto cervix 2.In second-degree prolapse - the prolapsed wall protrudes through the cervix but remains within the vagina. 3.In third-degree prolapse - the prolapsed fundus extends outside the vagina. 4. In fourth degree or total prolapse or procidentia - both the vagina and uterus are prolapsed 1 2 3 4

8. symptoms Feeling of something coming down per vaginum specially while she is moving Backache or Dragging pain in the pelvis Dysparenunia

9. symptoms Difficulty in passing urine, more the sternous effort less evacuation. Incomplete evacuation Urgency or frequency of micturation The woman may experience difficulty in passing stools and complete evacuation of bowels.

10. Clinical examination Inspection & palpation Vagina, rectum & recto-vaginal Pelvic examination Both dorsal & standing positions. The patient is asked to strain , this helps to demonstrate a prolapse which may not be seen at rest

11. management

12. Preventive management Adequate antenatal & intranatal care To avoid injury to the supporting structures during the time of vaginal delivery Adequate postnatal care To encourage early ambulance To encourage pelvic floor exercises General measures To avoid strenuous activities- heavy lifting To avoid pregnancies to soon

13. Conservative management Oestogen replacement therapy Kegal exercise Pessary treatment A vaginal pessary is an object inserted into the vagina to hold the uterus in place.

14. Surgical management Surgery should wait until symptoms are worse than the risks of having surgery. The surgical approach depends on: Degree of prolapse Desire for future pregnancies Often, a vaginal hysterectomy is used to correct uterine prolapse .

15. NURSING MANAGEMENT

16. Acute pain R/T pressure or tension of prolapsed uterus on supporting structures a) To assess the level of pain, cause, location, intensity to get base line data  b) To provide comfortable position to the patient to relieve discomfort i.e. lying down position  c) To provide comfort devices to patient to promote the level of comfort  d) To provide diversion therapy to the patient to divert the mind of the patient e) To provide analgesics to patient as prescribed by physician to relieve pain.

17. Risk for infection r/t prolapsed uterus as evidenced by decubitus ulcer a) To assess the sign & symptoms of infection. b) To assess the vital sign of the patient c) To encourage the patient not to touch the prolapsed area with unclean hands d) Provide prescribed antibiotics to patient

18. Anxiety related to uterine prolapse Explain all treatment and procedures Encourage verbalization of feelings by patient and family Provide information on treatment modalities.

19. Bibliography: 1) Dutta D.C 'Textbook of obstetrics' 6th edition published by new book agency (P) limited pp -312-313,421-422. 2)Jacob annamma ‘a comprehensive textbook of midwifery ‘1 st edition published by jitender p vij pp 539-55 3)www.Google.com

20. recaptulisation Fill in the blanks :- In first degree of prolapse of uterus the prolapsed wall extends upto _______ Ans. Extends up to cervix Procendentia is _______ Ans. When both the vagina and uterus are prolapsed

21. True/false Sense of something coming out per vaginum is felt in prolapsed uterus or not Ans. True Any increase in frequency or urgency of urine is felt in prolapsed uterus Ans. True