Successful Management of Uterine Prolapse in Pregnancy: A Case Report of Avoiding a Cervical Laceration by the Reduction of Massive Edema

TL;DR

A pregnant woman with a prolapsed uterus was successfully treated with gauze packing, avoiding cervical injury during delivery.

Contribution

A novel technique using gauze packing to reduce cervical edema and prevent laceration during pregnancy is presented.

Findings

Manual retraction with gauze packing significantly reduced cervical edema in a pregnant patient.

The patient delivered without cervical laceration or complications.

The technique may help prevent cervical dystocia and poor wound healing in edematous cervixes.

Abstract

We report a case of uterine prolapse in pregnancy, which was successfully managed before delivery. A 35-year-old woman (G2P1) complained consistently of a protruding uterus at 36 weeks gestation, and an engorged uterine cervix without tenderness, urinary disturbance, and incontinence were recognized (Pelvic Organ Prolapse Quantification (POP-Q) score C: +7). Manual retraction of the edematous cervix was gently performed with gauze packing, and strikingly improved edema of the cervix with a POP-Q score of C: -2 was observed one day after the gauze packing. Induction of labor was planned due to a suspected large-for-gestational-age infant, and the patient uneventfully delivered at 39 weeks gestation without any obstacles to delivery and cervical laceration. Cervical edema in pregnancy increases the risk of cervical dystocia and cervical lacerations. However, lacerations with edema are predicted to have a poor wound-healing process. The technique with gauze packing presented in this case may be useful in the protective handling of the uterine cervix during pregnancy.

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