Does pre-operative traction on the cervix approximate intra-operative uterine prolapse? A randomised controlled trial

Abstract

This study aims to compare pre-operative Pelvic Organ Prolapse Quantification (POP-Q) point C with and without cervical traction to that obtained intra-operatively in women undergoing pelvic organ prolapse surgery and to assess acceptability of examination with cervical traction without anaesthesia. Eighty-one women were randomised to having pre-operative examination with or without cervical traction to measure point C. Visual analogue scale (VAS) pain scores were recorded for each pre-operative examination. Comparisons were made between pre-operative and intra-operative findings. The mean difference between pre-operative and intra-operative point C in the non-traction group was statistically higher than in the traction group (3.2 vs 1.6 cm, p = 0.0001). The level of agreement between pre-operative point C measurement with traction and intra-operative point C measurement was better than pre-operative point C measurement without traction and intra-operative point C measurement on Bland and Altman plots. Women having cervical traction reported significantly greater pain score on the VAS (3.4 vs. 1.2, p < 0.0001). Compared to routine pre-operative examination with Valsalva and cough manoeuvres only, pre-operative examination with cervical traction had better agreement with intra-operative point C findings. Although women reported greater pain score when examined with cervical traction, it was still a tolerable and acceptable examination without anaesthesia.