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Uterine prolapse prevention in Eastern Nepal: the perspectives of women and health care professionals  [cached]
Radl CM,Rajwar R,Aro AR
International Journal of Women's Health , 2012,
Abstract: Christina M Rad,l Ranjita Rajwar, Arja R AroUniversity of Southern Denmark, Esbjerg, DenmarkAbstract: Uterine prolapse is a major reproductive health issue in Nepal. There is a wide range of literature available on the causes and risk factors of uterine prolapse and on the ways to prevent and treat it. There is still a lack of published evidence on what prevention and treatment services are working well or the attitudes toward them. This paper presents the findings of a qualitative study on primary and secondary prevention of uterine prolapse in Eastern Nepal.Method: The study involved eight focus group discussions with 71 women in six villages of the eastern districts of Siraha and Saptari and 14 qualitative interviews with health professionals from the local to central level. The group discussions and interviews covered the awareness levels of uterine prolapse and its prevention and treatment, as well as participants' opinions on and experiences with the services offered.Results: It was found that patriarchy, gender discrimination, and cultural traditions such as early marriage and pregnancy make it difficult for people to discontinue uterine prolapse risk behaviors. Women are aware of risk factors, prevention, and treatment, but are powerless to change their situations. Health professionals and women are fond of surgery as treatment, but opinions on the use of ring pessaries and pelvic floor muscle training are split.Conclusion: The main recommendation that can be drawn from this study is that research on the effectiveness of early treatments, such as ring pessaries and exercise, should be conducted. Furthermore, the involvement of other target groups (husbands, adolescents, and mothers-in-law) needs to be increased in order to make it easier for women to adapt low-risk behaviors. Finally, uterine prolapse prevention should be better integrated in national reproductive health services. Enforcing transparency, monitoring systems, and collaborations are important factors that should be considered as well.Keywords: uterine prolapse, primary prevention, secondary prevention, awareness, Nepal
Uterine prolapse prevention in Eastern Nepal: the perspectives of women and health care professionals
Radl CM, Rajwar R, Aro AR
International Journal of Women's Health , 2012, DOI: http://dx.doi.org/10.2147/IJWH.S33564
Abstract: erine prolapse prevention in Eastern Nepal: the perspectives of women and health care professionals Original Research (1603) Total Article Views Authors: Radl CM, Rajwar R, Aro AR Published Date July 2012 Volume 2012:4 Pages 373 - 382 DOI: http://dx.doi.org/10.2147/IJWH.S33564 Received: 04 May 2012 Accepted: 17 June 2012 Published: 31 July 2012 Christina M Rad,l Ranjita Rajwar, Arja R Aro University of Southern Denmark, Esbjerg, Denmark Abstract: Uterine prolapse is a major reproductive health issue in Nepal. There is a wide range of literature available on the causes and risk factors of uterine prolapse and on the ways to prevent and treat it. There is still a lack of published evidence on what prevention and treatment services are working well or the attitudes toward them. This paper presents the findings of a qualitative study on primary and secondary prevention of uterine prolapse in Eastern Nepal. Method: The study involved eight focus group discussions with 71 women in six villages of the eastern districts of Siraha and Saptari and 14 qualitative interviews with health professionals from the local to central level. The group discussions and interviews covered the awareness levels of uterine prolapse and its prevention and treatment, as well as participants' opinions on and experiences with the services offered. Results: It was found that patriarchy, gender discrimination, and cultural traditions such as early marriage and pregnancy make it difficult for people to discontinue uterine prolapse risk behaviors. Women are aware of risk factors, prevention, and treatment, but are powerless to change their situations. Health professionals and women are fond of surgery as treatment, but opinions on the use of ring pessaries and pelvic floor muscle training are split. Conclusion: The main recommendation that can be drawn from this study is that research on the effectiveness of early treatments, such as ring pessaries and exercise, should be conducted. Furthermore, the involvement of other target groups (husbands, adolescents, and mothers-in-law) needs to be increased in order to make it easier for women to adapt low-risk behaviors. Finally, uterine prolapse prevention should be better integrated in national reproductive health services. Enforcing transparency, monitoring systems, and collaborations are important factors that should be considered as well.
Uterine Prolapse: From Antiquity to Today  [PDF]
Keith T. Downing
Obstetrics and Gynecology International , 2012, DOI: 10.1155/2012/649459
Abstract: Uterine prolapse is a condition that has likely affected women for all of time as it is documented in the oldest medical literature. By looking at the watershed moments in its recorded history we are able to appreciate the evolution of urogynecology and to gain perspective on the challenges faced by today's female pelvic medicine and reconstructive surgeons in their attempts to treat uterine and vaginal vault prolapse. “He who cannot render an account to himself of at least three thousand years of time, will always grope in the darkness of inexperience” Goethe, Translation of Panebaker 1. Introduction This special issue provides urogynecologists with the opportunity to explore recent advances that have and will continue to propel our subspecialty forward. Simultaneously, it provides us with the opportunity to look back and appreciate the landmark moments that have led us to our current state of affairs. It is with this spirit, mindful of Goethe’s words, that this paper will focus its attention on a brief history of the management of uterine prolapse. 2. Antiquity to the Common Era Uterine prolapse is an ailment that has seemingly affected women for all of time. In fact, the problem of uterine prolapse and its potential treatment is described in the oldest documented medical literature, the Egyptian Papyri, where it is written, “of a woman whose posterior, belly, and branching of her thighs are painful, say thou as to it, it is the falling of the womb,” (Kahun papyrus ca. 1835 B.C.E.) [1]. The Ebers papyrus goes on to recommend “to correct a displaced womb: with oil of earth (petroleum) with fedder (manure) and honey; rub the body of the patient,” (Ebers papyrus ca. 1550 B.C.E.) [2]. Over one thousand years later, during the time of Hippocrates (c. 460–377 B.C.E.) and the subsequent generations that he influenced, the prevailing medical thought was that the uterus acted as an animal unto itself. This concept led to treatments such as fumigation, in which pleasant fumes would be placed at a woman’s head and vile ones near her prolapsed womb, in order to stimulate the uterus to retreat. Polybus, a pupil of Hippocrates (and his son-in-law), wrote in his noted text “On Diseases of Women,” of other therapies for uterine prolapse including the application of an astringent to the womb followed by placement of a vinegar soaked sponge, or halved pomegranate. If these measures failed, women were subjected to succussion—the practice of tying a woman upside down by her feet to a fixed frame and bouncing her repeatedly until her prolapse reduced then leaving her bed
Approach to concomitant rectal and uterine prolapse: case report  [cached]
Ate? Karateke,P?nar Batu,Mehmet Re?it Aso?lu,Sel?uk Sel?uk
Journal of the Turkish-German Gynecological Association , 2012,
Abstract: The classic description of rectal prolapse is a protrusion of the rectum beyond the anus. Peaks of occurrences are noted in the fourth and seventh decades of life, and most patients (80-90%) are women. The condition is often concurrent with pelvic floor descent and prolapse of other pelvic floor organs, such as the uterus or the bladder. In this study, two cases having contraindication to general anesthesia with rectal and uterine prolapse are presented. These cases were operated on under local anesthesia with support of sedation by Leforte and Delorme’s operation at the same time. In conclusion; pelvic floor disorders should be considered as a whole, and surgical correction of rectal prolapse and uterine prolapse may be done at the same time under local anesthesia with the support of sedation. Performance of these operations by experienced and trained pelvic reconstructive surgeons may be advocated.
Is uterine prolapse a cause of primary infertility?  [cached]
Rajiv Mahendru
Journal of the Turkish-German Gynecological Association , 2010,
Abstract: Presented in this report is apparently the first case of its kind in the medical literature where a woman with 11 years of primary infertility not only conceived following conservative surgery for uterine prolapse but also had a successful obstetrical outcome.
Uterine Prolapse in a Doe Goat: A Case Report
N. Wachida,A.I. Kisani
International Journal of Animal and Veterinary Advances , 2011,
Abstract: This study reports a case of uterine prolapse in a doe goat. The animal was brought to the hospital with complaint of prolapse of the uterus. The everted organ was carefully assessed and gross debris removed by washing with dilute chlorhexidine solution. Epidural anaesthesia was achieved using lignocain solution. The prolapsed uterus was replaced and retention suture was placed on the vulva to prevent reprolapse. Oxytocin, dexamethasone, broad-spectrum antibiotics (penicillin and streptomycin) were administered intramuscularly. The animal was hospitalized for closed monitoring. There was no recurrence. Sutures were removed and the animal was discharged from the hospital.
Laparoscopic sacrohysteropexy and myomectomy for uterine prolapse: a case report and review of the literature
Radwan Faraj, Jonathan Broome
Journal of Medical Case Reports , 2009, DOI: 10.1186/1752-1947-3-99
Abstract: Sacrohysteropexy can be carried out instead of vaginal hysterectomy in the treatment of uterine prolapse. It involves using a synthetic mesh to suspend the uterus to the sacrum; this maintains durable anatomic restoration, normal vaginal axis and sexual function. A laparoscopic approach has major advantages over the abdominal route including shorter recovery time and less adhesion formation. We describe a laparoscopic sacrohysteropexy in a 55-year-old Caucasian British woman that was technically difficult. An intramural uterine fibroid was encroaching just above the uterosacral ligament making mesh positioning impossible. This was removed and the procedure completed successfully.Posterior wall fibroid is not a contraindication for laparoscopic sacrohysteropexy. This procedure has increasingly become an effective treatment of uterine prolapse in women who have no indication for hysterectomy.Uterine prolapse is the protrusion of the uterus down into, and sometimes through, the vagina. It can affect quality of life by causing symptoms of pressure and discomfort, and by its effects on urinary, bowel and sexual function. Current treatment options include pelvic floor muscle training, use of pessaries and surgery.This case report discusses uterine suspension using mesh for uterine prolapse and involves attaching the uterus to the sacrum (sacrohysteropexy). This procedure preserves the normal uterus and can be performed via an abdominal or laparoscopic approach. Its efficacy and safety are discussed together with a review of the published literature.A 55-year-old Caucasian British woman was referred by her general practitioner with a dragging sensation in her lower pelvis and vagina of 18 months' duration. She described it as 'my womb is going to drop out'. She reported very vague symptoms during micturition and had recurrent cystitis. She did not complain of any bowel symptoms or urinary incontinence, and did not have significant sexual dysfunction.Two years before her pr
Successful management of uterine prolapse during pregnancy with vaginal pessary: a case report  [cached]
Esra Esim Büyükbayrak,Gülden Y?lmazer,Ay?e Gül ?zyap?,Bülent Kars
Journal of the Turkish-German Gynecological Association , 2010,
Abstract: We present a case of uterine prolapse complicating a second trimester pregnancy which was managed successfully with a vaginal pessary.Case: A 19 year-old primigravid woman referred to the obstetric emergency unit at the 16th week of gestation complaining of uterine prolapse. A silicone ring-shaped middle-size vaginal pessary was placed into the vagina. On each control visit, when the vaginal pessary was removed , the uterine prolapse still persisted until birth. The patient gave birth at 38th week by spontaneous vaginal delivery to a healthy baby. After birth, with uterine contractions, uterine prolapse regressed progressively.Conclusion: The management and treatment of uterine prolapse in pregnancy should be individualized depending on the patient’s preference. A vaginal pessary may be helpful to avoid complications of this condition and should be considered during patient counseling.
Prolapse of the Small Intestine from the Uterine Perforation at Dilatation and Curettage  [PDF]
Shigeki Matsubara,Akihide Ohkuchi,Hiroaki Nonaka,Homare Ito,Alan T. Lefor
Case Reports in Obstetrics and Gynecology , 2014, DOI: 10.1155/2014/164356
Abstract: Dilatation and curettage (D&C) sometimes causes uterine perforation, which usually does not cause a serious problem. Here, we report uterine perforation caused by D&C, in which the small intestine prolapsed from the uterus, requiring intestinal resection. D&C was performed for missed abortion at 9 weeks. After dilating the cervix, forceps grasped tissue that, upon being pulled, resulted in the intestine being prolapsed into the vagina. Laparotomy revealed a perforation at the low anterior uterine wall, through which the ileum had prolapsed. The mesentery of the prolapsed ileum was completely detached and the ileum was necrotic, which was resected. The uterus and the intestine were reconstructed. Although intestinal prolapse is considered to be caused by “unsafe” D&C performed by inexperienced persons or even by nonphysicians in developing countries, this occurred in a tertiary center of a developed country. We must be aware that adverse events such as uterine perforation with intestinal prolapse can occur even during routine D&C. 1. Introduction Conservative management is usually recommended for uterine perforation during dilatation and curettage (D&C); however, according to Williams Obstetrics Textbook [1] “considerable intra-abdominal damage can be caused by instrument passed through a uterine defect.” We here report a patient in whom the small intestine prolapsed through a uterine perforation to the vagina. Small intestinal mesentery was detached from the intestine, causing intestinal necrosis and requiring intestinal resection. 2. Case Presentation A D&C was performed on a 36-year-old 2 parous woman because of missed abortion at 9 weeks of gestation. She had undergone lower segment cesarean section twice. A gestational sac (GS) 34?mm in diameter with a 3?mm beatless embryo was observed within the uterine body, which was in slight anteversion and anteflexion. With a hygroscopic dilator placed for 12 hours, D&C was performed. Although abdominal ultrasound did not clearly show the sound, the procedure continued, expecting an “easy” D&C. The cervix was dilated with metal cervical dilator without difficulty. We usually use forceps and not a suction curette. We inserted the forceps into the uterine cavity, held the expected gestational sac, but felt slight difficulty in removing it, and immediately loosened the forceps. The intestine then prolapsed through the cervical ostium into the vagina (Figure 1(a)). Figure 1: Prolapsed small intestine and operative findings. (a) The small intestine is observed in the vagina. (b) The ileum is prolapsed through the
Vaginal hysterectomy for pelvic organ prolapse in Nepal  [PDF]
DK Sah,NR Doshi,CR Das
Kathmandu University Medical Journal , 2010, DOI: 10.3126/kumj.v8i2.3576
Abstract: Background: UVP is a significant Public Health Problem in Nepal. This problem is mainly prevalent in rural areas where the women are socio - economically less privileged and cannot afford the costs of treatment.
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