Does pre-operative traction on the cervix approximate intra-operative uterine prolapse? A randomised controlled trial.

Abstract

INTRODUCTION AND HYPOTHESIS:

This study aims to compare pre-operative Pelvic Organ Prolapse Quantification (POP-Q) point C with and without cervical traction to that obtained intra-operatively in women undergoing pelvic organ prolapse surgery and to assess acceptability of examination with cervical traction without anaesthesia.

METHODS:

Eighty-one women were randomised to having pre-operative examination with or without cervical traction to measure point C. Visual analogue scale (VAS) pain scores were recorded for each pre-operative examination. Comparisons were made between pre-operative and intra-operative findings.

RESULTS:

The mean difference between pre-operative and intra-operative point C in the non-traction group was statistically higher than in the traction group (3.2 vs 1.6 cm, p = 0.0001). The level of agreement between pre-operative point C measurement with traction and intra-operative point C measurement was better than pre-operative point C measurement without traction and intra-operative point C measurement on Bland and Altman plots. Women having cervical traction reported significantly greater pain score on the VAS (3.4 vs. 1.2, p < 0.0001).

CONCLUSIONS:

Compared to routine pre-operative examination with Valsalva and cough manoeuvres only, pre-operative examination with cervical traction had better agreement with intra-operative point C findings. Although women reported greater pain score when examined with cervical traction, it was still a tolerable and acceptable examination without anaesthesia.

• Authors: Fay L Chao, Anna Rosamilia, Peter L Dwyer, Alex Polyakov, Lore Schierlitz, Gerard Agnew
• Journal: International urogynecology journal (Int Urogynecol J) Vol. 23 Issue 4 Pg. 417-22 (Apr 2012) ISSN: 1433-3023 [Electronic] England
• PMID: 22278714 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Topics

• Adult
• Aged
• Aged, 80 and over
• Australia
• Cervix Uteri (diagnostic imaging, pathology)
• Cough
• Female
• Gynecologic Surgical Procedures (methods)
• Humans
• Intraoperative Period
• Middle Aged
• Pain Measurement
• Physical Examination (methods)
• Preoperative Care (methods)
• Prospective Studies
• Traction (methods)
• Ultrasonography
• Uterine Prolapse (pathology, surgery)
• Valsalva Maneuver