Correlation of preoperative and intraoperative assessment of pelvic organ prolapse by pelvic organ prolapse quantification system : a cross sectional study

Abstract

Objective- To correlate the assessment of pelvic organ prolapse between POP-Q score measured preoperatively with Valsalva manoeuvre and intraoperatively with mechanical traction. Design – Cross sectional Setting – Midnapore Medical College ,Midnapore , West Bengal , India Sample - Women attending gynaecology out patient department ( OPD) with symptomatic pelvic organ prolapse and planned for vaginal operative treatment between March 2019 to February 2020. Methods - Preoperative examination was done in OPD by POP-Q system with Valsalva manoeuvre and final examination was done under spinal anesthesia with mechanical traction. The correlation was done between pre and intraoperative measurements. Results: All intraoperative POP-Q measurements showed significant higher descent as compared with preoperative measurements (mean difference Aa 0.72cm, Ba 1.08cm, C 1.66cm, Ap 0.26cm,Bp 1.6cm, D 1.6cm, Gh 0.6cm,) except for Pb and Tvl. . Among all nine measurements the greatest difference between preoperative and intraoperative were observed for point C, D and Bp. Conclusion:Preoperative POP-Q score significantly differed when assessed intraoperatively under spinal anesthesia with traction. Patient should beinformed that the surgical plan might change depending on the intraoperative findings.Our study is an alert for both surgeon and patient.

Preoperative, Intraoperative and Postoperative Assessment of Pelvic Organ Prolapse by Pelvic Organ Prolapse Quantification System and Surgical Outcome

“…The standard POP-Q system has a long learning curve as some experience is required to exactly interpret the anatomical points. 4 In present study most of socio demographic characters were comparable to other studies. Though BM I> 30K gm 2 Chronic cough, constipation are risk factor for prolapse most of patient had BMI < 27 Kg m 2 with no cough and constipation.…”

“…Pelvic organ prolapse possess a major suffering in women life physically, psychosocially and economically. Symptomatic POP is typically treated with reconstructive surgery 4 . Pelvic organ prolapse develop due to loss of integrity of proximal vaginal level I support by uterosacral and cardinal ligaments.…”

“…However, with clinical examination the dominant prolapse may mask the additional compartment defects. i.e., the large anterior vaginal prolapse may compete with the uterus to be dominant prolapse and vice versa 4 . Before performing surgical reconstructive procedure, final vaginal examination is usually performed intraoperatively under anesthesia after mild traction of cervix in horizontal plane with vollsellum.…”