Ayurvedic Management of Congenital Elongation of Cervix- A Single Case Study

Elongation is one among the various congenital abnormalities of cervix, which is often one of the causes of primary infertility. The only available treatment is cervical amputation. The word yoni collectively refers to reproductive organs, however here it can be considered as the cervix. So elongated cervix can be correlated to Prasramsini Yoni Vyapat where there is laxity and descend of the cervix. All Acharyas have mentioned similar mode of treatment in case of Srasta Yoni which include Abhyanga, Sweda, Veshavara Bandha, Uttarabasti etc. A case report of patient presenting with congenital cervical elongation is being discussed here. In this case there was reduction in the elongation of the cervix by Veshavara Bandha and Uttarabasti with Jathyadi Taila. The drugs used in Veshavara Bandha were having Balya, Brimhana and Grahi properties which helped in reducing the length of the cervix significantly and preventing further elongation. Thus Ayurvedic management was found to be effective in elongation of cervix to an extent even though it cannot be cured completely.

Interobserver variability of ultrasound measurements for the differential diagnosis of uterine prolapse and cervical elongation without uterine prolapse

Objectives Our study aims to determine the interobserver variability of different ultrasound measurements (pubis-cervix distance, pubis-uterine fundus distance, and pubis-Douglascul-de-sac distance) previously analyzed for the ultrasound differential diagnosis of uterine prolapse (UP) and cervical elongation CE without UP. Materials and methods We conducted a prospective observational study with 40 patients scheduled to undergo surgical correction of UP and CE without UP. All patients underwent pelvic floor ultrasound examination by an examiner (E1) who acquired ultrasound images. Using these images, E1 measured the distances for the ultrasound differential diagnosis of UP and CE without UP, and these distances were compared with those measured by the other examiner (E2). Values were analyzed by calculating ICCs with 95% CIs. Results For UP, excellent reliability was obtained for all measurements except the pubis-Douglascul-de-sac measurement at rest, which was moderate (ICC 0.596; p = 0.028) and for the difference between the pubis-Douglascul-de-sac measurement at rest and during the Valsalva maneuver, which was good (ICC 0.691; p < 0.0005). For CE without UP, interobserver reliability was excellent for all measurements analyzed except the pubis-cervix measurement during the Valsalva maneuver, which was moderate (ICC 0.535; p = 0.052) and for the pubis-Douglascul-de-sac measurement at rest, which was good (ICC 0.768; p < 0.0005). Conclusions There is excellent interobserver reliability in measurements of the difference in the distance from the pubic symphysis to the uterine fundus at rest and during the Valsalva maneuver for both UP and CE without UP, which are used for the ultrasound differential diagnosis of UP and CE without UP.

Clinical Risk Factors for Uterine Cervical Elongation among Women with Pelvic Organ Prolapse

Background: Cervical elongation is commonly associated with pelvic organ prolapse (POP). It was an identified risk for recurrent prolapse after hysteropexy, requiring additional surgeries. The aim of the study is to investigate the risk factors for uterine cervical elongation among women with POP. Methods: In this single-center retrospective cohort study, women who underwent vaginal total hysterectomy for POP between 2014 and 2016 were collected. The cervical and total uterine lengths were measured by pathologists, while the ratio of cervical length to total uterine length were calculated. The cervical elongation is defined as corpus/cervix ratio ≤ 1.5. Results: A total of 133 patients were enrolled in this study. Among these patients, 43 women had cervical elongation and 90 women had normal length of uterine cervix. We found that age > 65 years old (67.4% vs. 42.2%, p = 0.007), total vaginal length ≥ 9.5 cm (65.1% vs. 45.6%, p = 0.035), uterine weight < 51 gm (72.1% vs. 52.2%, p = 0.03), and Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6) ≥ 12 (30.2% vs. 14.4%, p = 0.032) were associated with the risk of cervical elongation. There were no significant differences on preoperative urodynamic parameters in the two groups. Conclusion: The patient age > 65 years old, the total vaginal length of POP-Q system ≥ 9.5 cm, uterine weight < 51 g, and POPDI-6 ≥ 12 are independent risk factors of cervical elongation in women with POP. For women scheduled for pelvic reconstructive hysteropexy, concomitant cervical amputation should be considered.

A new method of organ-preserving surgical correction of cervical elongation using titanium mesh implants. The “Moscow” surgery

Objective. To study the efficacy and safety of the original technique for surgical correction of cervical elongation with vaginal wall prolapse (stage I–II) in patients of reproductive and menopause age. Patients and methods. The study included 17 patients aged 30 to 56 years with cervical elongation and vaginal wall prolapse. All patients underwent the original surgery – cervical amputation along with combined transobturator and sacrospinous TiMeshligature cervical suspension. Results. The patients were observed 1, 6, 12 and 18 months after surgery. Comparison of the patients’ questionnaire data in the pre- and postoperative periods showed an improvement in their quality of life, an increase in their social and sexual activity. During the first month, 10 (58.8%) patients noted intermittent episodes of perineal pain and 3 (17%) – frequent urination. Comprehensive clinical examination after 6, 12, and 18 months revealed complete preservation of surgical correction of prolapse in all patients. Gynecological and rectal examinations, transperineal and transvaginal ultrasound revealed no displacement of pelvic organs and titanium implants. There were no mesh-associated complications during follow-up. Conclusion. The developed original technique for surgical correction of cervical elongation with vaginal wall prolapse (stage I–II) using a combination of titanium mesh implants and non-absorbable ligatures with two-lateral suture anchor was shown to be effective and safe, as evidenced by normalization of the uterus position in the pelvis and absence of pelvic organ displacement and mesh-associated complications during follow-up. Key words: cervical elongation, stage I–II vaginal wall prolapse, titanium mesh implants, mesh-ligature correction of prolapse

Successful Management of Cervical Elongation During Pregnancy and Labor: A Case Report

Uterine prolapse and cervical elongation are rare conditions that can complicate pregnancy, labor, and its management. To minimize complications, proper management of this conditionis necessary. A 26-year-old woman referred to our outpatient clinic with a lump protruding from her vagina. She was 16 weeks pregnant. Physical examination revealed uterine prolapseand cervical elongation, so to prevent the complications of the protruded cervix, a pessary was inserted. She had the pessary during the first stage of labor until the rupture of membranes(at 6 cm cervical dilatation). After removal of the pessary, although the cervix was out of introitus, the active phase of labor initiated and a normal vaginal delivery was done. Newonset prolapse during pregnancy with more probability is due to cervical elongation. During labor and delivery, this condition could be managed with conservative methods, includingpessary placement. and this condition could be managed with conservative methods including pessary placement during pregnancy and labor.

A case report of recurrent uterovaginal prolapse and cervical elongation in anulliparous female with a distorted Pelvis

Recurrent uterovaginal prolapse adversely affects the life quality in women. Genitourinary prolapse affects around 40-50 % of women in their lifetimes with a higher incidence in women of advanced age and parity. It is less common in females of reproductive age, being particularly rare in nulliparous females. The reported incidence in this group is only 1%. In this case report we are highlighting a rare case of uterine prolapse in a young nulliparous woman after pelvic fracture. The cervix was also unusually long None of the previous surgeries took into account the elongated cervix with the prolapse, contributing to the so-called recurrence in this patient. The treatment of this patient was done by combining Sacro hysteropexy with Manchester Repair.