A Review of Pelvic Organ Prolapse During Pregnancy

Background: Pelvic organ prolapse in pregnancy has been extensively reported. In this review we assessed the current available literature detailing pelvic organ prolapse presenting in pregnancy to establish evidence with regards to antepartum, intrapartum and postpartum management. Methods: The following combination of search terms was used: ‘pregnancy’ and ‘pelvic organ prolapse’ or ‘prolapse’ or ‘cystocele’ or ‘rectocele’ or ‘vaginal prolapse’ or ‘cervical prolapse’ or ‘uterine prolapse’ and ‘outcomes’ or ‘treatment’ or ‘complication’ or ‘management’. A total of 450 citations were identified. Results: Antepartum prolapse is managed conservatively with pessaries and physiotherapy, though occasionally more active surgical intervention are required. Intrapartum complications in women going into labour with a prolapse are uncommon, however when they do occur the most common problem appears to be cervical dystocia and cervical lacerations. Mode of delivery remains controversial. Women usually have a recurrence of prolapse postnatally and treatment needs to be tailored to patient preferences. Conclusions: Although rare, pelvic organ prolapse (POP) complicating a pregnancy can be associated with significant problems both mentally and physically to women. Exclusive caesarean delivery may be a preventative strategy against pelvic organ prolapse, but this needs to be weighed up against the risks associated with repeat caesarean delivery.