Uterine prolapse during pregnancy is rare, with an estimated incidence of one in every 10,000 to 15,000 deliveries. Usually, ligaments and pelvic floor muscles hold the uterus and place it in its position. The weakening of muscles and ligaments due to damages or stretching can cause prolapse, dropping the uterus into the vagina (1) (2). The treatment is planned according to the degree of prolapse. Read on to know the causes, signs, and treatment of uterine prolapse in pregnancy and its complications.
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). 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).
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
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.
