Vaginal vault prolapse

Vaginal vault prolapse occurs in approximately 5% of women after hysterectomy. Most studies indicate that an equal proportion of women have had an abdominal or a vaginal hysterectomy which, given that abdominal hysterectomy is performed more frequently than vaginal, suggests that vaginal hysterectomy predisposes to vault prolapse. Vault prolapse is always accompanied by some degree of upper anterior and posterior vaginal prolapse, the latter usually being the predominant component. Frequently extensive vaginal epithelial stretching occurs and this is usually of the posterior vaginal wall (see Fig. 48.5). Failure to treat extensive vault prolapse may lead to ulceration and less commonly bowel extrusion.

Vaginal vault prolapse may be treated surgically by a vaginal sacrospinous colpopexy or an abdominal (or laparoscopic) sacrocolpopexy. A Cochrane review [11] has reported that the sacrocolpopexy has a higher cure rate and recurrence, when it occurs, will occur sooner with

a sacrospinous colpopexy. Dyspareunia appears to occur more frequently after sacrospinous colpopexy. The two procedures do not appear to produce any difference in urinary and bowel symptoms post-operatively. Sacro-colpopexy is associated with a longer recovery (when performed as an open procedure) and is therefore more expensive. Adverse events appear to occur with similar frequency and patient satisfaction rates are similar. Both procedures have the potential to cause large volume haemorrhage (sacrum for sacrocolpopexy and pudendal vessels for sacospinous colpopexy). There is conflicting evidence on which procedure produces a more correct anatomical result.

Mesh erosion is a significant problem after sacro-colpopexy and infrequently may lead to the need for complete mesh removal. Colpocleisis, whereby the vaginal lumen is completely occluded, may be used rarely in women who are unfit for major surgery and in whom conservative measures have failed. Strips of vaginal skin are removed from anterior and posterior vaginal walls and the two are sutured together.

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Pregnancy Diet Plan

Pregnancy Diet Plan

The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.

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