Prolapse MCQs

Supports of uterus have been discussed in detail earlier. Broad ligament (fold of peritoneum) and round ligaments are secondary supports of uterus and their role as support is doubtful. "Main support which prevents descent of the uterus is transverse cervical ligament (cardinal ligament) and its posterior extension the uterosacral ligament." Reference: Jeffcoate 7th/ed p 46

Gartner’s cyst – are cysts of the remnants of Wolffian duct. M/C location = Anterolateral aspect of vagina and hence are often confused with cystocele. Features of Gartner’s cyst are: Upper three-fifths above the hymen develop from the fused uterovaginal canal of the Müllerian ducts. Rugosities of the overlying vaginal mucosa are lost. Vaginal mucosa over it becomes tense and shiny. Margins are well defined. Not reducible. No impulse on coughing Reference: Dutta Gynae 6th/ed p 210.

The M/C complication of Purandare cervicopexy is deepening of pouch of douglas leading to enterocele formation. Enterocele can be prevented after purandare sling surgery by obliterating pouch of Douglas at the time of operation called Moscowitz repair. Reference : J B Sharma, Textbook of Gynecology 1 st edition p470

As discussed in preceding text enterocele is a long term complication of purandare sling surgery and not of shirodkar's. Drawbacks of shirodhkar's sling surgery: Injury to sigmoid colon Intestinal obstruction Injury to ureter Hemorrhage from mesenteric vessels Injury to genitofemoral nerve present in psoas muscle Reference: J B Sharma, Textbook of Gynecology 1 st edition p470

In females more than 60 years of age, who have medical complications like, in this patient previous H/O MI, hypertension and diabetes, Vaginal hysterectomy is not possible as the anesthetist will not agree to give anesthesia. In such patients procidentia/3° degree prolapse can be managed by Le fort's colpocleisis: In Le fort's repair/colpocleisis: The vaginal epithelium is removed followed by suturing of the anterior and posterior walls of denuded vagina therapy completely obliterating the vagina. The procedure is done under local anesthesia. Before performing this procedure, PAP smear and pelvic USG should be done to rule out cancers and pelvic pathology. Reference: Dutta Gynae. 5th/ed p 197-205; Shaw 15th/ed p

Fothergill's operation (Manchester Repair) is done in women below 40 years, who want to retain their menstrual function. The patient is less than 40 years and multiparous, so Fothergill's repair is the ideal management for them. Fothergill’s repair causes complications of pregnancy like incompetent os, habitual abortion and cervical dystocia therefore in a multipara who have completed their family we can do tubal ligation to prevent pregnancy. "If the family is completed, vaginal sterlization is to be done." Reference: Shaw 15th/ed p 339; Jeffocate 7th/ed p 289

Patient is presenting with a transverse lie with hand prolapse, i.e. the baby is dead so it should be managed as a dead baby with a transverse lie. Management in case of a dead baby with transverse lies – Cesarean section even in such cases, is much safer in the hands of those who are not conversant with destructive operations. Note: If this question is go for option a, i.e. LSCS, because in present day obstetrics there is no role of destructive procedures. Reference : Dutta Obs. 7/e, p 397, 585-587, Munrokerr 100/e, p 134, 135

Surgeries for Retroversion Baldy webster operation Modified Gilliam’s operation Laparoscopic ventrosuspension Since round ligament helps to keep the uterus in an anteverted position in all these surgeries, round ligaments are tightened. Reference: Jeffcoates 8/e, page 274.