Procidentia in pregnancy: a systematic review and recommendations for practice

Area of Science:

• Obstetrics and Gynecology
• Reproductive Medicine
• Women's Health

Background:

• Pelvic organ prolapse (POP) during pregnancy is a rare condition with evolving management and outcomes.
• Recent literature indicates improvements in worldwide management and prognosis for POP in pregnancy.

Purpose of the Study:

• To systematically review literature for cases of POP in pregnancy published since 1990.
• To identify common factors in presentation, management, and outcomes of POP in pregnancy.
• To derive concise recommendations for clinical practice based on case study analysis.

Main Methods:

• Systematic literature search of PubMed/MEDLINE, Scopus, and Google Scholar for POP in pregnancy cases since 1990.
• Review and summarization of published case reports to identify similarities in history, course, management, and outcomes.
• Inclusion of one case from own practice in the analysis.

Main Results:

• Analysis of 41 eligible case studies identified two types of POP in pregnancy: pre-existing (14 cases) and acute onset (27 cases).
• Pre-existing POP often resolves during pregnancy but recurs post-delivery; acute onset POP rarely resolves during pregnancy but frequently resolves postpartum.
• Common management included bed rest (20/41), pessary (15/41), and manual reduction (6/41). Complications included preterm labor (14/41) and cervical ulcerations (9/41). Vaginal delivery occurred in 22/41, with 15 cases requiring cesarean section due to prolapse.

Conclusions:

• Two distinct clinical entities of POP in pregnancy were identified based on onset, course, and outcome.
• Findings provide a basis for concise, evidence-based recommendations for managing POP in pregnancy.