prolapse organ pelvic 2010 rev hahaha
TRANSCRIPT
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PELVIC ORGANPROLAPSE
Prof.Junizaf,MD
Division of Urogynecology Reconstructive
Deptment of Obstetrics and Gynecology
Faculty of Medicine University of Indonesia
Jakarta
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DEFINITION
Pelvic organs prolapse is protrusion of
pelvic organs into the vaginal canal or
outside vaginal introitus
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PREVALENCE
50% women had previous vaginal delivery
20% gynecological cases who will be operated
come from pelvic organs prolapse
At RSCM-FKUI 2000 2005, 240 cases uterine
prolaps treatment by operation, the age of
patients years old 60
70 and parity three ormore
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ETIOLOGY
Damage or the weakness the pelvic
floor support
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PELVIC FLOOR ANATOMYDe Lancey
Endopelvic fascia
Levator ani muscles (pelvic diaphragm)
Urogenital diaphragm
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ENDOPELVIC FASCIA
Cardinal ligaments
Uterosacral ligaments
Rectovaginal fascia
Pubocervical fascia
Paracolpium fascia
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Upper vagina
Cervix Uterus
Cardinal ligaments
Uterosacral
ligaments
Pubocervical Fascia
Rectovaginal Fascia
Mid vagina
Lateral vaginalwall
Sacrum
Arcus Tendineus
Fascia PelvicFascia
paracolpium
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LEVATOR ANI MUSCLES
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LEVATOR ANI MUSCLES
(PELVIC DIAPHRAGM)
Pubococcygeus
Puborectalis
Iliococcygeus
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Arcus tendineus fasia pelvis
FA FA
Uretra
Vagina
Rectum
Pubococcygeus
muscle
LEVATOR ANI MUSCLES/ PUBOCOCCYGEUS
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NORMAL GENITAL POSITION
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Levator ani muscles functions to pull the
rectum, vagina, urethra, anteriorly
towards the pubic bones, compressing
their lumens closed.
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Primary support for the pelvic organs
come from the levator ani muscles.
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UROGENITAL DIAPHRAGM
Function:
Attach to the ischiopubic rami:the lateral walls of vagina perineal body
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PERINEAL BODY
Mass of dense connective tissue:
Fibers from: Bulbocavernosus
Superficial perinei transverse
External anal sphincter
Perineal membrane
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Perineum
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Type pelvic organs prolapse
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Risk Factor
Child birth
Parity
Chronic Intra abdominal pressure Age
Congenital
Genetic
Race
Obesity
Smoking
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ClassificationBaden Walker
Stadium I When the prolapse still on vaginal canal
Stadium II When the prolapse at introitus vaginal
Stadium III When the prolapse outside from introitus vaginal
prolapsus uteri
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POPQ
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Anatomic landmark used during pelvic organ prolapsed quantification
POPQ
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Aa
The point in the midline of the anterior vaginal wall 3cm proximal to the
urethral meatus, corresponding to the urethrovesical junction. Range: -
3 to +3
BaOn the anterior vaginal wall, the most dependent position between
point Aa and the vaginal cuff or anterior vaginal fornix
C Cervix or vaginal cuff (posthysterectomy)
DPosterior fornix corresponding to the pouch of Douglas (in the absence
of cervix)
ApThe point in the midline of posterior vaginal wall 3 cm proximal to the
hymenal ring. Range -3 to +3
BpOn the posterior vaginal wall, the most dependent position between
point Ap and the vaginal cuff or posterior fornix
GhGenital hiatus - midportion of the urethral meatus to the posteriormargin of the genital hiatus
PbPerineal body - between posterior margin of the genital hiatus and the
midportion of the anus
TVL Total vaginal length - greatest depth of the vagina
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Staging of pelvic organ prolapsed
Stage 0 : No prolapse is demonstrated. Points Aa, Ap, Ba, and Bp are all at -3cm and either point C or point D is within 2 cm of TVL
Stage I : The most distal portion of the prolapse is l cm above the level of thehymen (above -1)
Stage II : The most distal portion of the prolapse is l cm or less proximal to ordistal to the hymen.
Stage III : The most distal portion of the prolapse is 1 cm below the hymen butprotrudes no further than 2 cm less than the TVL.
Stage IV : Complete eversion of the total length of the lower genital tract.Distal protrusion quantify >+ [TVL-2] cm. leading edge of theprolapse: cervix or vaginal cuff scar.
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SYMPTOMS
Sensation bulging at introitus vaginal
Sensation of vaginal of pelvic fullness
Back pain and disminish when lying
Vaginal discharge or bleeding
Urinary incontinence
Constipation
Sexual complaints
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Diagnosis
Anamnesis
Physical examination Gynecology examination
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TREATMENT
Prevent Limitations vaginal delivery
Prevent second stage more than two hours
Prevent vaginal delivery by instrument
Prevent placental delivery by crede metode
Repair laseration pelvic floor after vaginaldelivery
Kegel exercise
Prevent or treatment condition can cause intra
abdominal pressure increase
Treatment
Conservative
Operative
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Conservative Treatment
Pessary
Estrogen hormon, special for oldest
women
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OPERATIVETREATMENT
Anterior colporrhaphy
Posterior colporrhaphy
Ventrofixation Vaginal hysterectomy
Colpoperineorhaphy
Colpocleisis
Uterosacropexy
Sacrospinosus fixation
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