Uterine Prolapse During Pregnancy

Pregnancy can affect a woman in many unexpected ways. The fluctuating hormones, physiological and psychological changes that a pregnant woman goes through can give rise to certain issues. One such incidence can be the development of uterine or cervical prolapse during pregnancy.

Although a rare event, uterine prolapse during pregnancy can prove dangerous for both the mom and her baby. It can trigger problems like cervical infections, haemorrhaging, preterm labour and even miscarriage. Its treatment may involve surgical interventions which can further expose a pregnant woman to added risks. Therefore, the best course of action can be to undertake preventive measures to avoid any likelihood of uterine prolapse.

What is Uterine Prolapse in Pregnancy?

The uterus (womb) of a woman which holds the unborn baby is a muscular form that’s usually supported inside her pelvis by many tissues, muscles, and ligaments. Certain factors during pregnancy can cause these muscles and ligaments to weaken, relax or stretch. Lack of enough support may make the uterus leave its location and descend into the vagina or the birth canal. This medical condition of the fallen womb is called uterine prolapse or cervical prolapse. However, it may be significant to take into consideration that the incidence of uterine prolapse during pregnancy is not a common happening.

Types of Uterine Prolapse

Uterine or cervical prolapse commonly is of two sorts:

1. Complete Uterine Prolapse

A complete prolapse happens when the uterus drops down so far that some part of the uterus may project out of the vaginal opening.

2. Incomplete Uterine Prolapse

An incomplete prolapse ensues when the uterus partially falls into the vagina but does not come through.

Different Stages of Cervical Prolapse

Muscle relaxation or weakness may let the uterus dip down partly or completely out of the vagina in different stages. The different stages indicate the extent to which the uterus has descended.

• First Stage: During this stage, the cervix slumps into the upper vagina.
• Second Stage: In this stage, the cervix declines lower to the level close to the vagina’s opening.
• Third Stage: In this state, the cervix slides outside the vagina.
• Fourth Stage: In this condition, the uterus is totally out of the vagina.

What Are the Complications of Pregnancy Uterine Prolapse?

Some of the complications of pregnancy uterine prolapse can be:

• Minor cervical infection
• Acute urinary retention
• Urinary tract infection
• Preterm labour
• Miscarriage
• Risk of dystocia (obstructed labour) during delivery
• Uterine rupture causing foetal death and maternal mortality
• Ulceration of the visible tissue
• Prolapse of other organs like the rectum or the bladder

Who is At Risk of Cervical Prolapse?

Not enough scientific literature is available on cervical prolapse because it occurs rarely. It may be difficult to say why some pregnant women develop this condition. However, factors like advanced age of the pregnant woman, BMI, increased intra-abdominal pressure, history of congenital weakness of pelvic muscles may put some pregnant women at a greater risk of cervical prolapse. Also, a woman who may have suffered pelvic trauma during difficult delivery or prolonged labour in her earlier vaginal delivery is also at an increased risk. The changing pregnancy hormones may result in increased levels of progesterone, cortisol, and relaxin in some cases, triggering hypertrophic cervical elongation which can adversely affect the pelvic floor muscles holding the uterus and provoke cervical prolapse.

Causes of Uterine Prolapse in Pregnancy

Some of the causes of uterine prolapse in pregnancy can be:

• Obstetric history of large babies or difficult deliveries
• Congenital connective tissue syndrome
• Excessive weight gain during pregnancy
• Previous childbirth trauma resulting in weak pelvic floor muscles
• Augmented intrabdominal pressure
• Severe coughing due to asthma or bad bronchitis
• Overstraining because of constipation
• A pelvic tumour or fibroids
• Past surgery in the pelvic part leading to weakening of muscles
• Physiological variations owing to hormonal changes prompting cervix softening

Signs & Symptoms of Uterine or Cervical Prolapse

Few signs and symptoms of uterine prolapse can be:

• A constant feeling of heaviness in the perineum
• Increased discharge from the vaginal introitus (during the second trimester)
• Some tissue protruding out of the vagina
• Urinary issues like urine retention or urine leakage
• Difficulties having bowel movements
• Having a feeling of sitting on a tiny ball or sinking feeling like something is dropping out of the vagina
• Sexual concerns like experiencing trouble while having sex or feeling of looseness in the vaginal tissue

Diagnosing Uterine Prolapse While Pregnant

Your doctor may make a diagnosis of cervical or uterine prolapse during a pelvic examination by inserting a speculum which will allow him to check the vagina and uterus. During the pelvis inspection, your doctor may also ask you to push down as if experiencing a bowel movement. Doing so may aid your doctor to evaluate how far down the uterus has fallen into the vagina. He may also ask you to stiffen the muscles of your pelvis as if you are controlling the flow of urine to ascertain the strength or firmness of the pelvic muscles.

Treatment for Uterine Prolapse in Pregnant Women

The course of treatment usually rests on the severity of the specific case. Your doctor may suggest inserting a vaginal pessary (a rubber ring) into your vagina which will provide support to the sagging tissues and maximum rest. A pessary may have to be removed from time to time for cleaning. In severe cases, the doctor may recommend a minimally invasive vaginal surgery (laparoscopy). Some doctors may consider elective cesarean section followed by a peripartum hysterectomy.

Can Pelvic Floor Muscle Exercises Really Help?

Pelvic floor strength training or Kegel exercises can prove useful in not only preparing women for delivery but also in alleviating the symptoms of uterine prolapse. Studies indicate that women who regularly practise pelvic floor muscle exercises can avert most of the problems associated with cervical prolapse. Therefore, every expectant mother may find it helpful to make these exercises a part of their daily exercise regime.

How Soon Can Floor Muscle Exercises Help to Improve Uterine Prolapse?

Women who have mild uterine prolapse can perform floor muscle exercises to tackle the symptoms and support their pelvic floor which may help reverse the development of the condition. It is important to regularly perform them and use proper techniques for the exercises to be effective.

How Can You Prevent Uterine or Cervical Prolapse?

Here are some handy tips which may help you prevent prolapsed womb in pregnancy:

• Do regular Kegel exercises to toughen your pelvic floor muscles which may help thwart the occurrence of a prolapsed cervix while pregnant.

• Drink adequate amounts of water and healthy fluids, include high-fibre foods like green vegetables, fruits, whole-grain cereals in your diet which may regulate the bowel movements and prevent constipation.

• Avoid lifting heavy stuff. In case you need to lift, bend your legs instead of bending from the waist or back.

• If you suffer from bronchitis, treat it at the earliest.

• Keep a check on weight gain. You can consult a dietician for weight-loss strategies if necessary.

Adopting a healthy lifestyle by expectant moms may help them reduce their chances of developing uterine prolapse. Regular exercises, nutritious diet, an active routine may facilitate a smooth pregnancy and a safe delivery.