Uterine prolapse in the pregnant primigravida

Abstract

M. A., a 35-year-old Japanese primigravida, was first seen during the thirty-second week of pregnancy. Her medical and surgical history was unremarkable. Physical examination revealed a normal pregnancy compatible with 32 weeks’ duration. No uterine prolapse, cystocele, or rectocele was present at that time. There was a mild ectropion of the uterine cervix, which later became marked and caused a few episodes of bloody discharge during the thirty-sixth and thirty-seventh weeks of pregnancy. Otherwise, her prenatal course was uneventful until the beginning of the fortieth week when she developed, suddenly, a seconddegree uterine prolapse associated with a mild degree of cystocele and rectocele. The entire cervix was outside the introitus, being enlarged and edematous with marked ectropion (Fig. 1). She had mild pressure symptoms but no pain or incontinence. A Smith-Hodge pessary was inserted. It remained in the vagina the remaining days of her pregnancy. Five days later (at the end of the fortieth week), she went into labor, and the pessary was removed. The labor was normal as illustrated in Fig. 2, with the use of mild sedation and later epidural anesthesia. The fetal presenting part descended rapidly without interference by the condition of the cervix, which dilated quite normally. Normal fetal heart rate patterns were observed by continuous monitoring with a fetal scalp electrode throughout the last half of labor. After a second stage of only 14 minutes, a healthy baby girl weighing 3,076 grams was bon spontaneously over a median episiotomy. No cervical laceration or extension of the episiotomy was noted. There Fig. I. Uterine prolapse at 40 weeks’ gestation. Edematous enlargement of the cervix with marked ectropion and erosion is seen.