Relationship of degree of uterine prolapse between pelvic examination in lithotomy position with cervical traction and pelvic examination in standing position

Abstract

© 2018, The International Urogynecological Association. Introduction and hypothesis: The Pelvic Organ Prolapse Quantification (POP-Q) assessment is a standardized tool for evaluating pelvic organ prolapse (POP). However, intraoperative evaluation reveals greater apical prolapse than do POP-Q scores. There is a need to implement a method for performing POP-Q at the outpatient clinic that reveals maximal prolapse and causes the least pain. This study was performed to compare the degree of uterine prolapse between POP-Q with cervical traction and POP-Q in the standing position. Secondary objectives were to compare pain and acceptability scores between the two examinations. Methods: Women with uterine prolapse stage I or II by routine examination were invited to participate. Comparison of degree of uterine prolapse, POP-Q stages, acceptability score, and pain score between the two types of examinations were undertaken. Results: Seventy-eight participants were recruited. The median point C in routine POP-Q examination was −5 (−9 to +1), −0.5 (−3 to +4) with cervical traction, and −4 (−7 to +2) in the standing position. When examined with cervical traction, 61.5% women were upstaged by one and 9.0% by two compared with examination in the standing position; 39.7% reported visual analog scale (VAS) pain scores of ≥5 under examination with traction, but only 2.6% reported that level of pain in the standing position. There was no significant difference in acceptability scores between groups. Conclusion: In an outpatient clinic setting, POP-Q examination with cervical traction revealed maximal prolapse at an acceptable level of pain. Accordingly, this method is recommended for POP-Q examination.