Uterine prolapse

Pelvic organ prolapse quantification (POP-Q) examination[32]Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996 Jul;175(1):10-7. http://www.ncbi.nlm.nih.gov/pubmed/8694033?tool=bestpractice.com [33]Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010 Jan;21(1):5-26. http://www.ncbi.nlm.nih.gov/pubmed/19937315?tool=bestpractice.com [34]Haylen BT, Maher CF, Barber MD, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016 Apr;27(4):655-84. https://link.springer.com/article/10.1007/s00192-016-3003-y http://www.ncbi.nlm.nih.gov/pubmed/26984443?tool=bestpractice.com

The POP-Q examination measures nine points on the vagina and perineum relative to the hymen: six internal points and three external points. Stages are based on the maximal extent of prolapse relative to the hymen, in one or more compartments:

• Stage 0: no prolapse

• Stage I: the most distal prolapse is >1 cm above the level of the hymen

• Stage II: the most distal prolapse is between 1 cm above and 1 cm below the hymen (i.e., at the hymen)

• Stage III: the most distal prolapse is >1 cm below the hymen but no further than 2 cm less than the total vaginal length. [Figure caption and citation for the preceding image starts]: Apical prolapse POPQ stage IIIFrom the personal collection of Prof L. Brubaker and Dr L. Lowenstein; used with permission [Citation ends].

• Stage IV: represents procidentia/total prolapse. [Figure caption and citation for the preceding image starts]: Total uterovaginal prolapse (procidentia) POPQ stage IVFrom the collection of Prof L. Brubaker and Dr L. Lowenstein; used with permission [Citation ends].

Baden–Walker halfway scoring system[35]Baden WF, Walker T. Fundamentals, symptoms and classification. In: Baden WF, Walker T, eds. Surgical repair of vaginal defects. Philadelphia, PA: JB Lippincott; 1992:14.

In the Baden–Walker system, the vagina is divided into six areas: two anterior, two superior, and two posterior. Each area of the vagina is assigned a grade from 0 to 4, according to the degree of descent relative to the hymen when the patient is straining maximally:

• Grade 0: normal position for each respective site

• Grade 1: descent halfway to the hymen

• Grade 2: descent to the hymen

• Grade 3: descent halfway past the hymen

• Grade 4: maximum possible descent for each site.

The Baden–Walker system is no longer commonly used because it is imprecise and not reproducible.