NURSING CARE OF CLIENTS: PROBLEMS WITH

THE PASSENGER AND THE POWERS OF LABOR

MALPRESENTATIONS
& MALPOSITIONS
 TOPIC OVERVIEW
• Abnormal lie, malpresentation and malposition

• Malposition and its management

 OccipitoPosterior
 OccipitoTransverse

• Malpresentation and its management

 breech
 face
 brow
 shoulder
 compound
 DEFINITIONS
• Abnormal lie where the long axis of the fetus is not lying along
the long axis of the mother’s uterus

TRANSVERSE
OBLIQUE
UNSTABLE 

• LONGITUDINAL (MAY BE EITHER CEPHALIC OR BREECH) is

NORMAL
 DEFINITIONS
• Malposition where the fetus is lying
longitudinally and the vertex is presenting, but
it is not in the OccipitoAnterior (OA) position

OccipitoTransverse (OT)

 OccipitoPosterior (OP)
                       

Occiput Anterior Positions 

          
 MALPOSITION
Malpositions include occipitoposterior and occipitotransverse positions of
fetal head in relation to maternal pelvis.

Occiput Posterior
Occiput Transverse

Arrested labor may occur when the head does

not rotate and/or descend. Delivery may be It is the incomplete rotation of OP to OA
complicated by perineal tears or extension of results in the fetal head being in a horizontal
an episiotomy. or transverse position (OT).
Factors that favour malposition
Pendulous abdomen- in multipara
Anthropoid pelvic brim- favors direct
O.P/O.A
Android pelvic brim

A flat sacrum-transverse position

The placenta on the ant. uterine wall

 How to diagnose :
Course of labour usually normal, except for prolonged second stage
(>2hours)
Abdominal examination :
a) Lower part of the abdomen is flattened
b) Difficult to palpate fetal back.
c) Fetal limbs are palpable anteriorly
d) Fetal heart may be heard in the flanks

Vaginal examination:
a) Posterior fontanelle towards the sacral-iliac joint (difficult)
b) Anterior fontanelle is easily felt, if head deflexed
c) Fetal head may be markedly molded with extensive caput, making 9

diagnosing correct station and position difficult.

 Management:
Spontaneous rotation to occiput anterior occur in 90% of
cases.
• Esp. in good uterine contraction, spacious pelvis, average
size fetus.
• If arrest of labour occur in second stage of labour
1. Emergency Cesarean section
2. Ventouse delivery.

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 DEFINITIONS
• Malpresentation where the fetus is lying longitudinally,
but presents in any manner other than vertex

BREECH
FACE
BROW
SHOULDER
 COMPOUND
 
 MALPRESENTATION
Types and Incidence:

• Breech 3 in 100
• Face 1 in 500
• Brow 1 in 2000
• Shoulder 1 in 300
• Compound
 Breech Presentation
The perinatal mortality can be up to 4 times that of vertex
presentation. Complications are:
– Increased risk of prolapsed cord.
– Increased risk of CTG abnormalities.
– Mechanical difficulties with delivery of shoulders/head

Types of Breech Presentation:

Frank (Extended) Breech Presentation
Complete (Flexed) Breech Presentation
Footling Breech Presentation
 ETIOLOGY

Maternal Fetal Placental

• Polyhydramnios • Prematurity • Placenta previa
• Oligohydramnios • Multiple
• Uterine pregnancy
abnormalies • Fetal anomalies
(bicornuate, (hydrocephalus,
uterus) anencephaly
• Pelvic tumour
• Uterine surgery
 Frank Breech Complete Breech

The baby's bottom comes first, The baby's hips and knees
and the legs are flexed at the are flexed so that the baby is
hip and extended at the knees sitting cross legged, with
(with feet near the ears).
feet beside the bottom.
65-70% of breech babies are in
the frank breech position.
 Footling Breech Kneeling Breech

One or both feet come first, with The baby is in a kneeling

the bottom at a higher position. position, with one or both legs
This is rare at term but relatively extended at the hips and flexed
common with premature fetuses at the knees. This is extremely
rare.
 BREECH PRESENTATION
-- Management

At or after 36 weeks

Confirmation by ultrasound

Elective Caesarian Section

Vaginal breech delivery

External Cephalic Version

(ECV)
 BREECH PRESENTATION
-- External Cephalic Version
• Attempt external cephalic version if:
– Breech presentation is present at or after 37 weeks
– Vaginal delivery is possible; success rate varies according
to experience’s hand mostly 50%
– Should be performed with tocolytics agent, should last not
more than 10 minutes, fetal heart rate trace must be
performed before and after procedure
– There are no contraindications (e.g. fetal abnormality,
placenta previa uterine bleeding, previous uterine surgery,
hypertension, multiple gestation, Oli- or Poly- hydramnios).
 BREECH PRESENTATION
-- External Cephalic Version
• Risks:
– Placental abruption
– Premature rupture of the membranes
– Cord accident
– Transplacental haemorrhage(remember anti-D
aministration in Rhesus-negative women)
– Fetal bradycardia
 BREECH PRESENTATION
-- Vaginal Breech Delivery
• Term Breech trial –3% increased risk of
increased perinatal mortality.Prerequisites:
• Criteria:

• Frank / complete • Experienced .Fetal blood

breech obstetrician in sampling from
• No evidence feto- breech delivery buttocks provides
pelvic disporpotion • Fetal well being accurate assesment
• Estimated fetal and progress of of acid base status
weight: <3.5Kg labour should be Epidural anesthesia
• Flexed fetal head carefully monitores maybe
advantageous.
Principle: Masterly inactivity(Hands-off)
• The following points are important for the safe
conduct
of a breech delivery:
• Don’t be in hurry.
• Never pull from below and let the mother expel the
fetus by her own effort with uterine contractions
• Always keep the fetus with its back anterior
• Keep a pair of obstetrics forceps ready should it
become necessary to assist the aftercoming head
• Anesthetist and pediatrician should attend the
delivery
• Inform the operation theater, if C/S is needed.
 Face Presentation
- head is hyper extended
- presenting part is face
- denominator is chin (mentum)
- between glabella & chin
- presenting diameter is submentobregmatic (9.5cm)

• AETIOLOGY
Maternal Fetal

• Multiparity • Congenital Malformation

• Lateral obliquity of fetus
• Contracted pelvis / CPD
• Flat pelvis
(anencephaly)
• Several coils of umbilical cord around
the neck
• Musculoskeletal abnormality (spasm/
shortening of extensor muscle of neck)
• Tumors around neck (congenital goiter)
 FACE PRESENTATION
-- Diagnosis
• Is caused by hyperextension of the
fetal head so that neither the occiput
nor the sinciput are palpable on vaginal
examination.

• On abdominal examination, a groove

may be felt between the occiput and
the back.

• On vaginal examination, the face is

palpated, the examiner’s finger enters
the mouth easily and the bony jaws are
felt.
 FACE PRESENTATION
-- Diagnosis

• The chin serves as the

reference point in
describing the position of
the head.

• It is necessary to
distinguish only chin-
anterior positions in which
the chin is anterior in
relation to the maternal
pelvis from chin-posterior
positions.
 FACE PRESENTATION
-- Management

• Prolonged labour is common.

• Descent and delivery of the head by flexion
may occur in the chin-anterior position.
• In the chin-posterior position, however, the
fully extended head is blocked by the sacrum.
This prevents descent and labour is
impossible→ caesarean section
 Brow Presentation
• The brow presentation is caused by partial extension of the
fetal head so that the occiput is higher than the sinciput.
• Causes same like face presentations,although some arise as a
resut of exagerated extension OP.

• Diagnosed in labour by vaginal examination:palpating

anterior frontanele,supraorbital ridge and nose.

• MGT: Only can be achieved by deliver by caesarean

section
Mentovertical D = 13.5cm
 Shoulder Presentation
• Occurs as a result of transverse lie or
oblique lie

• Predisposing factors = placenta

previa,high parity,pelvic tumour,uterine
anomaly

• On abdominal examination, neither the

head nor the
buttocks can be felt at the symphysis
pubis and the head
is usually felt in the flank.

• On vaginal examination, a shoulder may

be felt, but not always. Delay in diagnosis
risk cod prolapse and uterine rupture.

• Delivery should be by Caesearean

Section.
 Compound Presentation
• Occurs when an arm
prolapses alongside
the presenting part.
Both the prolapsed
arm and the fetal
head present in the
pelvis
simultaneously.
Management

• Replacement of the prolapsed

arm
• Assist the woman to
assume the knee-chest
position
• Push the arm above the
pelvic brim and hold it
there until a contraction
pushes the head into the
pelvis. 
• Proceed with
management for normal
childbirth
• If the procedure fails or if the
cord prolapses, deliver by
caesarean section
 SUMMARY
Presentation Management

Breech Vaginal delivery ± ECV/

Caesarean section
Face Vaginal delivery (chin-anterior)/
Caesarean section (chin-
posterior)

Brow Caesarean section

Shoulder Caesarean section

Compound Replacement of prolapsed arm

 Vaginal delivery/ Caesarean
section
 The Woman Who Develops a
Complication During Labor and Birth
Hypotonic Uterine Contraction

The number of contractions is usually low or

infrequent
May occur after the administration of analgesia
especially if the cervix is not dilated to 3 or 4 cm or
if bowel and bladder distension prevents descent or
from engagement.
Management
Start oxytocin infusion

Amniotomy, to further speed labor

In the first hour after birth palpate the uterus and
assess lochia every 5 minutes.
Hypertonic Contractions
Are marked by an increased in resting tone.
Management:
Rest and pain relief with a drug such as morphine
sulfate.
Darkening room lights.
Decrease noise and stimulation
Cesarean birth maybe necessary.
 POSTMATURE PREGNANCY
General information
 Defined as those pregnancies lasting beyond the end of the
42nd week.
 Fetus at risk due to placental degeneration and loss of
amniotic fluid
 Decreased amounts of vernix also allow the drying of the
fetal skin, resulting in a dry, parchment like skin condition
Medical management
 Directed toward ascertaining precise fetal
gestational age and condition, and
determining fetal ability to tolerate labor
 Induction of labor and possibility cesarean
birth
Nursing Interventions
 Perform continual monitoring of
maternal/fetal vital signs
 Support mother through all testing and labor
 PROLAPSED UMBILICAL CORD
General information
 Displacement of cord in a downward direction, near
or ahead of the presenting part, or into the vagina
 May occur when membranes rupture.
 Associated with breech presentation, unengaged
presentations and premature labor
 Obstetric emergency if compression of the cord
occurs, fetal hypoxia may result in CNS damage or
death.
Assessment findings
 Vaginal examination identifies cord prolapsed into
vagina
PROLAPSED UMBILICAL CORD
 Nursing Interventions
 Check FHT immediately when membranes rupture, and
again after next contraction, or within 5 minutes; report
decelerations
 If fetal bradycardia, perform vaginal examination and
check for prolapsed cord
 If cord prolapsed into vagina, exert upward pressure
against presenting part to lift part off cord, reducing
pressure on cord
 Get help to move the mother into a position where
gravity assist in getting presenting part off cord (knee
chest position or high trendelenburg’s)
 Administer oxygen for immediate cesarean birth
 If cord protrudes outside vagina, cover it with sterile
gauze moistened with sterile saline while carrying out
above tasks. Do not attempt to replace cord.
 FETAL DISTRESS
General information
 Cord compression
 Placental abnormalities
 Preexisting maternal disease
Assessment findings
 Decelerations in FHR
 Meconium-stained amniotic fluid with a
vertex presentation
Nursing interventions:
 Check FHR on appropriate basis
 Conduct vaginal exam for presentation and
position
 Place mother on left side, administer oxygen,
check for prolapsed cord, notify physician
 Support mother and family
 Prepare for emergency birth if indicated
 DYSTOCIA
General information
 Any labor/delivery that is prolonged or difficult
 Usually results from a change in the
interrelationships among the 4 P’s that is the
factors in labor and delivery
 Frequently seen causes include:
 disproportion between fetal presentation (usually the
head) and the maternal pelvis (CPD)
 if disproportion is minimal, vaginal birth may be
attempted if fetal injuries can be minimized or
eliminated.
 cesarean birth needed if disproportion is great.
– problems with presentation
» any presentation unfavorable for
delivery (e.g. breech, shoulder, face,
transverse lie)
» posterior presentation that does not
rotate, or cannot be rotated with ease.
» cesarean birth is the usual intervention
– problems with maternal soft tissue
 Nursing Interventions
 Individualized as to cause
 Provide comfort measures for client
 Provide clear, supportive descriptions of all actions
taken
 Administer analgesia if ordered
 Prepare oxytocin infusion for induction of labor as
ordered.
 Monitor mother/fetus continuously
 Prepare for cesarean birth if needed
 Shoulder dystocia
Shoulder dystocia happens when
after delivery of the head the
anterior shoulder is trapped
and arrested behind
symphysis pubis.
Fetal complications:
1. Erbs palsy
2. Fracture humerus and clavicle
3. Abnormal neurologic
examinations
SHOULDER DYSTOCIA
Management of shoulder dystocia
Mc Robert’s Maneuver- flexing legs of the parturient sharply over the abdomen
Woodcorkscrew maneuver- rotating anterior shoulder 180
degrees to dislodge it
 Cleidotomy- cutting the
clavicles
 Rubins maneuver- rocking the
shoulders from side by side by
applying force over the
abdomen
 Suprapubic pressure
 Strong fundal pressure
• Rotate posterior arm to anterior
position
• Extraction of posterior arm
• All procedures should not take
more than five minutes
 PRECIPITOUS LABOR AND DELIVERY
General Information
• Labor less than 3 hours
• Emergency delivery without clients physician
or midwife
Assessment findings
• As a labor is progressing quickly, assessment
may need to be done rapidly.
• Client have history of previous precipitous
labor and delivery
Nursing Intervention:
 If you have to deliver the baby
yourself:
 Asses the client’s affect and ability to
understand directions, as well as other
resources available
 Stay with the client at all times
 Do not prevent birth of the baby
 Maintain sterile environment if possible
 Rupture membranes if necessary
 Support baby’s head as it emerges,
preventing too-rapid delivery with gentle
pressure
 Use gentle aspiration with bulb syringe to
remove blood and mucus from nose and
mouth
 Deliver shoulders after external rotation,
asking mother to push gently
 Provide support for baby’s body as it
delivered
 Hold baby in a head down position to
facilitate drainage of secretions
 Promote cry by gently rubbing over back
and soles of feet
 Dry to prevent heat loss
 Place baby on mother’s abdomen
 Check for signs of placental separation
 Check mother for excess bleeding, massage
uterus PRN
 Hold placenta as it delivers
 Cut cord when pulsation cease, if cord
clamped available, if no clamps keep it
intact.
 Wrap baby in dry blanket, give to mother,
put to breast if possible
 Check mother for fundal firmness and
bleeding
 Record all pertinent data
 Comfort mother and family as needed
 SPONTANEOUS DELIVERY
• The encirclement of the largest head diameter by the
vulvar ring is known as crowning.
• RITGEN MANEUVER
* gloved hand is used to exert pressure on the chin of the
fetus through the perineum just in front of the coccyx
* allows controlled delivery of the fetal head
* favors extension of the fetal head
RITGEN MANEUVER
 AMNIOTIC FLUID EMBOLISM
General information
 Escape of amniotic fluid into the maternal circulation,
usually in conjunction with a pattern of hypertonic,
intense uterine contractions, either naturally or
oxytocin induced.
 Obstetric emergency; may be fatal to the mother or to
the fetus.
Assessment findings
 Sudden onset of respiratory distress, hypotension,
chest pain, signs of shock
Bleeding
Cyanosis
Pulmonary edema
Nursing Intervention
 Initiate emergency life support activities for mother.
administer oxygen
utilize CPR in case of cardiac arrest
 establish IV line for blood transfusion
 administer medication to control bleeding as
ordered
 prepare for emergency birth of baby
 keep client/family informed as possible
 INDUCTION OF LABOR
General Information
 -Deliberate stimulation of uterine
contractions before the normal occurrence
of labor.
Medical management
 Amniotomy (the deliberate rupture of the
membrane)
 Oxytocins, usually Pitocin
 Prostaglandin in gel/suppository form to
improve cervical readiness
Assessment findings
 Indication for use
Postmature pregnancy
Preeclampsia/eclampsia
Diabetes
Premature rupture of membranes
 Condition of fetus; mature, engaged
vertex fetus , no distress
 Condition of mother; cervix “ripe” for
induction, no CPD
Nursing Interventions
 Explain the procedure to client
 Prepare appropriate equipment and medications.
 Amniotomy; a small tear made in amniotic
membrane as part of sterile vaginal exam
 Oxytocin (Pitocin); IV administration
“piggybacked” to main IV
 Know the continuous monitoring and accurate
assessment are essential.
 Discontinue oxytocin infusion when fetal distress,
hypertonic contractions occur, signs of obstetric
complications appear. (hemorrhage/shock,
abruption placenta, amniotic fluid embolism)
 Notify physician of any untoward reactions.
RUPTURED UTERUS
A ruptured uterus is
characterized by a tearing
or splitting of the uterine
wall during labor; it is
usually a result of a
thinned or a weakened
area that cannot withstand
the strain and force of
uterine contraction.
ASSESSMENT
Risk factor:
1. Multiparity
2. Obstructive labor
3. Improper use of pitocin
4. Large fetus
5. Weakened, old cesarean section scar
6. External forces such as trauma
Clinical manifestations:
 Pain above the symphysis pubis
 Sudden, acute abdominal pain during a contraction
 Vaginal bleeding, shock; fetal distress
 Uterine Rupture
Treatment:
Surgical: laparotomy to
remove fetus, followed by
a hysterectomy.
Medical management:
1. Blood transfusion
2. Prophylactic antibiotics
Nursing Intervention:
Provide nursing management associated with
hemorrhage.
Assess for early diagnosis:
Maternal mortality rate is high
Prognosis for fetus is poor; fetus usually dies as a
result of anoxia caused by placental separation.
 INTRAUTERINE FETAL DEATH
Intrauterine fetal death is also called fetal demise.

ASSESSMENT:
 Absence of FHR and fetal movement.
 Negative pregnancy test result
 Ultrasound examination determines absence of FHR
and occurrence of fetal skull collapse.
Nursing Intervention:
Goal: To support the couple through the grieving process.
• Encourage expression of feelings; do not minimize the
situation or event.
• Provide opportunity for the couple to spend time with
still born, if they so desire.
• Monitor for complication.
Premature labor
 Overview
• Preterm labor (also called premature labor) is
labor that begins before 37 weeks of pregnancy.
 
• Because the fetus is not fully grown at this time,
it may not be able to survive outside the womb.
 
• Health care providers will often take steps to try
to stop labor if it occurs before this time.

1
 Overview
• A baby born before 37 weeks of pregnancy is
considered a preterm birth (or premature
birth).
• Preterm births occur in about 12 percent of all
pregnancies in the U.S.
• It is one of the top causes of infant death in this
country.

2
 Risks
Health care providers currently have no way of
knowing which women will experience preterm
labor or deliver their babies preterm.  But there
are factors that place a woman at higher risk for
preterm labor or birth:
-- Certain infections, such as bacterial vaginosis
and trichomoniasis

3
 Risks
-- Shortened cervix
-- Previously given birth preterm
http://www.nichd.nih.gov/health/topics/preterm_l
abor_and_birth.cfm

4
 Living and Coping
Premature infants may face a number of health
challenges, including:
-- Low birth weight
-- Breathing problems because of underdeveloped
lungs
-- Underdeveloped organs or organ systems

5
 Living and Coping
-- Greater risk for life-threatening infections
-- Greater risk for a serious lung condition, known
as respiratory distress syndrome
-- Greater risk for cerebral palsy (CP)
-- Greater risk for learning and developmental
disabilities

6
 Living and Coping
They may need to stay in the hospital for several
weeks or more, often in a neonatal intensive care
unit (NICU).
http://www.nichd.nih.gov/health/topics/preterm_l
abor_and_birth.cfm

7
 Management
• The administration of a corticosteroid to the
fetus appears to accelerate the formation of
lung surfactant.
• If the pregnancy is under 34 weeks, a woman
may be given a steroid (betamethasone) to
attempt to hasten fetal lung maturity (two
doses of 12 mg betamethasone given
intramuscularly 24 hours apart, or four doses of
6 mg dexamethasone given intramuscularly 12
hours apart).
7
 Management
• Although calcium channel blockers such as
nifedipine (Procardia) or a prostaglandin
antagonist such as indomethacin (Indocin) can
be used as tocolytic agents, these are not drugs
of choice because of their side effects.

• Magnesium sulfate, once a popular drug to halt

contractions, is no longer recommended
because of its many side effects (Simhan &
Caritis, 2007)
7
 Management
• Ritodrine hydrochloride (Yutopar) and
terbutaline (Brethine) are examples of drugs
that act almost entirely on beta-2 receptor sites
and so have only mild hypotensive and
tachycardiac effects.
• Of these two drugs, terbutaline, is more
frequently used. As a beta-2 receptor, it causes
blood vessels and bronchi to relax along with
the uterine muscle.
• As a result, hypotension can occur. This causes
the heart rate to in-crease to move blood more
effectively.
7
 Management
TERBUTALINE SIDE EFFECTS

• Hypokalemia may occur from a shift of

potassium into cells, and blood glucose and
accompanying plasma insulin levels may
increase.
• Pulmonary edema may occur. Headache,
because of the dilatation of cerebral blood
vessels, is a common side effect; nausea and
emesis also may occur.

7
 Management
TERBUTALINE SIDE EFFECTS
• These are side effects to be observed for but are
not reasons to discontinue therapy.

• Terbutaline should be used cautiously in women

with diabetes mellitus and thyroid dysfunction.

• In a woman who is predisposed to develop

gestational diabetes, terbutaline can raise her
blood sugar glucose so much that she becomes
overtly diabetic, which further complicates her
pregnancy.
7
 Management

• After contractions halt, a tocolytic infusion

usually is continued for 12 to 24 hours, and
then oral administration of terbutaline is begun.

• The first oral dose is given 30 minutes before

the intravenous infusion is discontinued to
prevent any drop in the serum concentration.

7
 Management
• After this initial stabilization, a woman will
continue to take an oral tocolytic until 37
weeks’ gestation or until fetal lung maturity is
established by amniocentesis.

• Before hospital discharge, teach a woman how

to take her pulse before each dose of
medication and to call if her pulse rate is more
than 120 beats per minute or if she experiences
palpitations or extreme nervousness.

7
 Management
• Women must set their alarm clocks so they
awaken at night to take the around-the-clock
dose prescribed. Otherwise, their serum level of
medication in the morning could be too low to
be effective.
• Caution that if they forget a dose, they must
take a pill as soon as they remember and then
space their doses accordingly from that time.
• They should not double the dose to make up for
the missed pill because extreme tachycardia
could result.
7
Uterine prolapse
 DEFINITION
Uterine prolapse is falling or sliding of the womb (uterus)
from its normal position into the vaginal area.
• Uterine prolapse (also called descensus or procidentia)
means the uterus has descended from its normal
position in the pelvis farther down into the vagina.

• Uterine prolapse is one type of pelvic organ prolapse ,

and it is the second most common after
cystourethrocele (bladder and urethral prolapse).
 Causes, incidence, and risk factors

-Muscles, ligaments, and other structures hold the uterus in the pelvis.
If these muscles and structures are weak, the uterus drops into the
vaginal canal . This is called prolapse.
-This condition is more common in women who have had one or more
vaginal births.
-Other things that can cause or lead to uterine prolapse include:
• Normal aging
• Lack of estrogen after menopause
• Anything that puts pressure on the pelvic muscles, including chronic
cough and obesity
• Pelvic tumor (rare)
-Long-term constipation and the pushing associated with it can make
this condition worse.
 Symptoms

• Feeling like you are sitting on a small ball

• Difficult or painful sexual intercourse
• Frequent urination or a sudden urge to empty the bladder
• Low backache
• Uterus and cervix that stick out through the vaginal opening
• Repeated bladder infections
• Feeling of heaviness or pulling in the pelvis
• Vaginal bleeding
• Increased vaginal discharge
-Many of the symptoms are worse when standing or sitting for long
periods of time.
 Signs and tests

-A pelvic examination is done while you are bearing down, as if you

were trying to push out a baby. This shows your doctor how far your
uterus has dropped.
• Mild terine prolapse is mild when the cervix drops into the lower
part of the vagina.
• Uterine prolapse is moderate when the cervix drops out of the
vaginal opening.
-The pelvic exam may also show that the bladder and front wall of the
vagina (cystocele), or rectum and back wall of the vagina (rectocele)
are entering the vagina. The urethra and bladder may also be lower
in the pelvis than usual.
 Treatment

- Treatment is not necessary unless the symptoms

bother you. Many women seek treatment by the
time the uterus drops to the opening of the vagina.
- Treatment is surgical, and the options
include hysterectomy or a uterus-sparing techniques
such as Hysteropexy or Manchester procedure.
 LIFESTYLE CHANGES

• Weight loss is recommended in obese women with

uterine prolapse.
• Heavy lifting or straining should be avoided, because
they can worsen symptoms.
• Coughing can also make symptoms worse. If you a
chronic cough, ask your doctor how to prevent or
treat it. If you smoke, try to quit. Smoking can cause
a chronic cough.
 VAGINAL PESSARY

• The doctor may recommend placing a rubber or

plastic donut-shaped device, called a pessary, into
the vagina. This device hold the uterus in place. It
may be temporary or permanent. Vaginal pessaries
are fitted for each individual woman. Some are
similar to a diaphragm used for birth control.
• Pessaries must be cleaned from time to time,
sometimes by the doctor or nurse. Many women can
be taught how to insert, clean, and remove the
pessary herself.
 Side effects of pessaries include:

• Foul smelling discharge from the vagina

• Irritation of the lining of the vagina
• Ulcers in the vagina
• Problems with normal sexual intercourse and
penetration
 SURGERY
 Surgery should not be done until the prolapse symptoms are worse
than the risks of having surgery. The specific type of surgery
depends on:
• Degree of prolapse
• Desire for future pregnancies
• Other medical conditions
• The women's desire to retain vaginal function
• The woman's age and general health
• There are some surgical procedures that can be done without
removing the uterus, such as a sacrospinous fixation . This
procedure involves using nearby ligaments to support the uterus.
Other procedures are available.
• Often, a vaginal hysterectomy is used to correct uterine prolapse.
Any sagging of the vaginal walls, urethra, bladder, or rectum can be
surgically corrected at the same time.
 Expectations (prognosis)

• Most women with mild uterine prolapse do not have

bothersome symptoms and don't need treatment.
• Vaginal pessaries can be effective for many women
with uterine prolapse.
• Surgery usually provides excellent results, however,
some women may require treatment again in the
future.
 Complications

• Ulceration and infection of the cervix and vaginal

walls may occur in severe cases of uterine prolapse.
• Urinary tract infections and other urinary symptoms
may occur because of a
cystocele. Constipation and hemorrhoids may occur
because of a rectocele.
 Prevention

• Tightening the pelvic floor muscles using Kegel

exercises helps to strengthen the muscles and
reduces the risk of uterine prolapse.
• Estrogen therapy, either vaginal or oral, in
postmenopausal women may help maintain muscle
tone in the vaginal area.
Thank you …..