(Abstracted from Am J Obstet Gynecol 2017;217:436.e1–436.e8)
The most critical component of apical vaginal support is compromised at time of total hysterectomy unless specific apical support procedures (ASPs) are performed. When level I support is lost in women without prolapse and not reestablished in those with prolapse, these patients may be at risk of future vaginal vault prolapse.
Obstetrics and Gynecology (W.T.R., M.R.M., J.L.L.) and Medicine and Surgery (M.A.O.), Washington University in St Louis; Obstetrics and Gynecology, Barnes-Jewish Hospital (W.T.R., M.R.M.), St Louis, MO; and Obstetrics and Gynecology, St Francis Hospital and Medical Center, Hartford, CT (J.P.S.)