Prolapse in pregnancy: what to worry about?

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Organ prolapse during pregnancy can be a medical emergency, with a prolapsed uterus or umbilical cord requiring surgery. Obstetricians may use a pessary device to keep the uterus in place. Bladder prolapse may require a cesarean delivery, and umbilical cord prolapse may require emergency surgery. Symptoms include a feeling of fullness or something falling out of the vagina, incontinence, and a bulge in the vaginal canal. Pelvic floor exercises can help prevent organ prolapse.

Prolapse of internal organs in pregnancy could be a cause for emergency medical attention, depending on which organ slips from its normal position. A prolapsed bladder in pregnancy usually occurs without complications, but a prolapsed uterus or umbilical cord may require emergency surgery. Pregnancy is one cause of organ prolapse, along with aging, obesity, and loss of estrogen from menopause or hysterectomy.

Obstetricians commonly monitor a uterine prolapse during pregnancy to see how severe it is. They may prescribe a pessary device to keep the uterus in its normal position as the pregnancy progresses. A pessary refers to a round device commonly constructed of silicone that is inserted into the vagina. It provides support to the weak muscles that allow the uterus to descend into the vaginal canal.

Women who experience bladder prolapse during pregnancy may need to have a cesarean delivery to avoid aggravating the condition. This occurs when the wall between the bladder and the vagina stretches and weakens, allowing part or all of the bladder to slip into the canal. The urethra, the tube that carries urine from the bladder for disposal, may also slip into the vagina. Ligaments that stretch during pregnancy and childbirth are the most common cause of bladder prolapse.

Prolapsed umbilical cord might require emergency surgery if oxygen to the baby is impeded. Umbilical cord prolapse in pregnancy may occur before the baby’s head engages in the birth canal, usually in the later stages of pregnancy. This condition cannot be prevented, and doctors typically perform a C-section to safely remove the baby.

Umbilical cord prolapse is more common if a newborn is positioned sideways in the uterus instead of head down. It also occurs more often in women who have given birth to twins and triplets. Experts believe that too much fluid in the uterus, or when the water breaks too soon, could lead to prolapse of the umbilical cord in pregnancy. They advise women who see or feel the umbilical cord in the vagina to seek medical attention.

Symptoms of a prolapsed organ include a feeling of fullness or that something is falling out of the vagina. This feeling could become uncomfortable, especially if a woman has been on her feet for most of the day. The sensation of a bulge in the vaginal canal and incontinence are further signs of a prolapsed internal organ. Some women leak urine when they cough or sneeze, urinate frequently, or cannot empty their bladder completely.
In addition to the weakened muscles caused by pregnancy, constipation also contributes to organ prolapse. Women who suffer from connective tissue disorders, such as lupus or rheumatoid arthritis, are also at an increased risk of these conditions. Pelvic floor exercises help some women strengthen the ligaments and muscles that hold the pelvic organs in place. Called Kegel exercises, they involve contracting and releasing the muscles that hold urine.




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