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Double pessary use in grade 4 uterine and vaginal prolapse
D L Myers1, C A LaSala, J A Murphy
1Department of Obstetrics and Gynecology, Women and Infants' Hospital of Rhode Island, Brown University School of Medicine, Providence 02905, USA.
Background:
Certain situations dictate conservative management of grade 4 uterine or vaginal vault prolapse in women. The reduction of a prolapse may not be possible if the vagina cannot retain a single pessary. We have used double pessaries in the management of this condition.
Technique:
With the patient in the dorsal lithotomy position, either a Donut or Inflatoball (Milex Products Inc., Chicago, IL) pessary is inserted and pushed into the vagina as far as is comfortable. A second pessary, either a flexible Gellhorn or Shaatz (Milex Products Inc.), then is placed caudad to the first.
Experience:
We have used this approach in five women who have been followed for 7-15 months. There have been no erosions or vaginitis and all the women experienced symptomatic relief.
Conclusion:
In women who want or require conservative management of grade 4 prolapse and are unable to retain a single pessary, the placement of two pessaries often will be successful.