Fun with pessaries

Question 1

Choose all correct answers:

a) pessaries indicated for SUI symptoms are designed with more anterior support to stabilize the urethra
b) women choosing pessary as first line option were more likely to be dissatisfied with result compared to those choosing surgery first line
c) the cube and gellhorn are examples of space-occupying pessaries
d) predictors of discontinuation of pessary include old age and lack of incontinence symptoms

Answer 1

a) true
b) false -equal satisfaction
c) true
d) false -young age and incontinence sx are both predictors of discontinuation

Question 2

What is the treatment for an incarcerated uterus in pregnancy?

Answer 2

Hodge pessary until 18 weeks (at this point uterus is out of pelvis and symptoms typically relieved)
-caused by retroverted uterus becoming trapped in pelvis -can also try to manipulate to anteverted position under conscious sedation/anesthesia

Question 3

What type of pessary has been shown to decrease the risk of pre-term birth in women with a short cervix (<22mm at 22weeks GA) or hx cervical insufficiency

Answer 3

Arabin pessary (not currently available in Canada)

Question 4

What type of pessary would you recommend for each of these patients?

a) still sexually active
b) wide Introitus (more than 3-4 finger-breadths)

Answer 4

a) ring/shaatz

b) cube/gellhorn

Question 5

List potential complications of pessary use

Answer 5

discharge most common, erosions (2-9%), infections (BV, yeast), fistula most serious (usually only in forgotten pessaries), vaginal cancer (rare, in neglected pessaries)