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MRCOG PART 2 SBAs and EMQs

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EMQ1478
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prevention of vault prolapse

prevention of vault prolapse Posted by uma M.
outline measures to be taken to prevent post hysterectomy vault prolapse.

posthysterectomy vault prolapse has an incidence of 1.8%, more after hysterectomy for prolapse.A thorough preop assessment of women undergoiung hysterectomy is essantial. If patient is undergoing surgery for prolapse , she should be evaluayed for weakness in all compartments as pelvic floor defects especially after birthtrauma are global.All defects should be identified & corrected even if patient is asymptomatic.Identification of enterocele and addressing to this is essential. uterosacral ligament must be coapted to prevent later prolapse.vault suspension with suturing &attaching cardinal ligaments to vaginal vault has not shoe to be beneficial. post op adjuant physiotherapy might help.
Identify any predisposing conditions like COPD, constipation, physical stress prior to surgery &treat them
If pt is for hysterectomy due to other conditions rather than prolapse, identify any pelvic floor weakness prior to surgery to correct during surgery.coaptation of uterosacral has shon to prevent later enterocele & vault prolapse.


















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