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Apical Descent in the Office and the Operating Room: The Effect of Prolapse Size

Crosby, Erin C. MD*; Sharp, Kristen M. MD; Gasperut, Adrian MD*; DeLancey, John O.L. MD*; Morgan, Daniel M. MD*

Female Pelvic Medicine & Reconstructive Surgery:
doi: 10.1097/SPV.0b013e31829c6365
Original Articles
Abstract

Objectives: The support of the uterine cervix with Valsalva or cough assessed in the clinic and the support of the uterine cervix with traction in the operating room often differs. The objectives of this study were to test the null hypothesis that the difference between preoperative and intraoperative values of pelvic organ prolapse quantification (POP-Q) point C is not related to prolapse size and to determine if other factors exist that predict this difference.

Methods: This is a retrospective review of women who had a vaginal hysterectomy in the Female Pelvic Medicine and Reconstructive Surgery division between 2005 and 2011 and had preoperative and intraoperative POP-Q point C recorded. A difference of 5 cm was established by a panel of urogynecologists as clinically significant. Student t tests and χ2 analyses were used and a logistic regression performed.

Results: There were 206 subjects included. The mean difference in point C between the 2 clinical settings was 3.5 cm. A difference of 5 cm or greater was present in 33%. The mean difference in point C was larger for women with lesser stages of prolapse (stage 1, 5.8 cm; stage 2, 3.0 cm; stage 3/4, 1.4 cm; P<0.001). A difference of 5 cm or greater in point C was more often present in women with lesser stages of prolapse: 70.3% of women with stage 1 prolapse, 9.3% of women with stage 2 prolapse, and 8.5% of women with stage 3 prolapse (P<0.001).

Conclusions: We reject our null hypothesis. A difference of 5 cm or greater between POP-Q point C in the clinic and the POP-Q point C in the operating room occurred more frequently in women with lesser stages of prolapse.

Author Information

From the *Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; and †Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI.

Reprints: Erin C. Crosby, MD, Department of Obstetrics and Gynecology, L4000 Women’s Hospital, 1500 E Medical Center Dr, SPC 5276, Ann Arbor, MI 48109. E-mail: ecrosby@med.umich.edu.

This research was funded by ORWH grant P50 HD044406.

The authors have declared they have no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins