Risk Factors of Uterovaginal Prolapse

Abstract

Background: Pelvic organ prolapse refers to protrusions of the pelvic organs into or out of the vaginal canal. Vaginal prolapse can occur without uterine prolapse but uterus cannot descend without carrying the upper vagina with it. Therefore, genital prolapse is divided into two broad categories; one is uterine prolapse the other is vaginal prolapse. They are again divided into different subgroups. Objective: To find out risk factors that will help to reduce the incidence of uterovaginal prolapse. Method: It is a retrospective case control study conducted in the department of Obst & Gynae, BSMMU, Dhaka during the period of October 2009 to June 2010. We included 50 uterovaginal prolapse women as a case and 50 reasonably healthy women as a control. Vault prolapse after abdominal hysterectomy, vaginal hysterectomy, only cystocele, only rectocele, was excluded from study. Results: In this study, 62% women were 45-65 years of age and in control group this was 46%, P value was .001. In case group most of the women were multiparous, 84% were > 5, in control group this was 20%. P value was .001. Most of the patients had history of repeated childbirth, <3yrs, in control group it was >5yrs, p value is 0.001 which is highly sigficant. Most of the patients were coming from low socio-economic condition. In case group it was 56% and control group 34%, P value was 0.191. In this study, most of the patient had history of prolong labour (14.6%). Instrumental delivery 0.4% In case group, 80% patients showed easy vaginal delivery, 4.2% had obstructed labour. Almost 100% patients had history of something coming down per vagina. 42% complaining of frequency, 58% incomplete voiding, 10% retention of urine, 4% had stress incontinence, P value of incomplete voiding .001. 74% patients had history of constipation and 30% patients had history of difficulty in defecation. P value .001. 68% in case group complaining watery per vaginal discharge, 12% in control group. P Value .001. 22% in case group complaining of chronic cough, P value .001. 74% cases signifiquent history of heavy physical work. P value .001. 72% cases were 2nd degree uterine prolapse, 18% 1st degree and 10% 3rd degree prolapse. Conclusion: Early marriage, difficult childbirth, low socio-economic condition, poor nutrition status, delivery conducted by untrained dais, no rest in puerperium and complication of delivery are found to be recommended risk factors of utero-vaginal prolapse. In our socio-economic condition, it is need of ours to strengthen the existing maternal services at the basic level of community and build up the awareness to overcome & remove the risk factors of prolapse.