POP

Question 1

Major supports of the uterus

Answer 1

Transverse cervical ligaments
Uterosacral ligaments

Question 2

Level 1 support (Apical)

Answer 2

 Transverse cervical ligaments (also called Cardinal or Mackenrodt’s ligaments)
 Uterosacral ligaments

Question 3

Level 2 support (Transverse or Horizontal)

Answer 3

 Levator ani and arcus tendinous fascia
 Pubocervical fascia
 Rectovaginal fascia

Question 4

Level 3 support

Answer 4

 Perineal body

Question 5

Middle/ apical compartment defect

Answer 5

Enterocele: herniation of the pouch of Douglas through the posterior vaginal fornix. It may
contain bowel or omentum
 Vaginal vault prolapse: Inversion of the apex of the vagina following abdominal/vaginal
hysterectomy
 Uterovaginal prolapse

Question 6

Indications of pessaries

Answer 6

Prolapse found within 6 months of delivery
Patients who are unfit for or cannot withstand surgery
Patient does not want/refuses surgery
To promote healing of decubital ulcers before surgery
Patient on a long waiting list for surgery
Therapeutic test, where it is difficult to establish if symptoms are due to prolapse