LESSON PLAN

ON
genital prolapse

Name of the Teacher --- Mrs. Shwetha Rani C.M.

Class --- 2nd year Msc Nursing

 Subject --- Obstetric and Gynecology Nursing

Topic --- Genital prolapse

Group of the student ---

Time --- 1 hr

Date ---

AV Aids --- Black Board , Chart , O.H.P.

Medium of instruction --- English

Method of teaching --- Lecture cum Discussion

Previous knowledge of the group --- The group has less knowledge regarding uterine prolapse.
 Central objective:
At the end of the class the student will be able to define genital prolapse, describe the aetiological factors, signs and symptoms,
aggrevating factors, define the uterine prolapse, clinical examination and diagnosis of uterine prolapse and the treatment modalities of
uterine prolapse.
Specific objective:
 Introducing the topic
 List out the etiology of prolapse
 Describe the aggravating factors of prolapse
 Explain about uterine prolapse
 State down the etiology of uterine prolapse
 List down the degree of uterine prolapse
 Describe the symptoms of uterine prolapse
 Describe the clinical examination and diagnosis of uterine prolapse
 Enumerate the treatment of uterine prolapse.

Sl Time Specific Contents Teacher’s Learner’s A V aids Evaluation

.no Objective activity activity
1. 2min introducing the Introduction:
topic Genital prolapse is one of the common clinical conditions Introducing
met Listens Black What are the female
in day to days gynaecological practice specially amongst the the topic. board genital organs ?
parous women. The entity includes descent of the vaginal wall
and or the uterus. It is infact a form of hernia.

2. list out the Etiology of the prolapse: Describing Listens and Charts What are the
etiology of the The genital prolapse occurs due to weakness of the the aetiology noteofin the aetiology of prolapse?
prolapse. structures supporting the organs in position. The factors the prolapse. book
are grouped as
 Predisposing factor
Acquired
Congenital
 Aggravating factor

Acquired :
Vaginal delivery with consequent injury to the supporting
structures is the single most important acquired predisposing factor in
producing prolapse. The prolapse is unusual in cases
delivered by caesarean section.
The injury is caused by
 Overstretching of the Mackenrodt’s and uterosacral
ligament.
 Overstretching of the endopelvic fascial sheath of the
vagina.
  Overstretching of the perineum.
 Subinvolution of the supporting structures.

Congenital factors
Congenital weakness of the supporting structures is
responsible for nulliparous prolapse or prolapse following an
easy vaginal delivery. In such cases, anatomic and functional
abnormalities may be observed such as short vagina,
increased paravaginal tissue laxity even in nulliparous state.
One should be on the look out for an occult spina bifida
and associated neurological abnormalities.
3. describe the Aggrevating factors Explains Listens Black Which are the
aggrevating  Post menopausal atrophy board aggrevating factors
factors of  Increase intra-abdominal pressure as in chronic cough and that cause genital
prolapse constipation. prolapse?
 Increase weight of the uterus as in fibroid or
myohyperplasia.
 Undernutrition.
 Traction by the anterior vaginal wall or cervical polyp.
These factors possibly operate where the supports of the
genital organs are already weakened.
Vaginal prolapse:
 Anterior wall:
Cystocele – the cystocele is formed by the laxity and
 descent of the two-thirds of the anterior vaginal wall. As the
bladder base is closely related to the area, there is herniation of
the bladder through the lax anterior wall.
Urethrocele – when there is laxity of the lower third of the
anterior vaginal wall, the urethra herniates through it. This may
appear independently or usually along with cystocele and is called
cysto-urethrocele.
 Posterior wall:
Relaxed perineum --Torn perineal body produces gaping introitus
with bulge of the lower part of the posterior vaginal wall.
Rectocele – There is laxity of the middle third of the posterior
vaginal wall and the adjacent recto vaginal septum. As a result, there
is herniation of the rectum through the lax area.

Vault prolapse:
 Enterocele – laxity of the upper third of the posterior
vaginal wall results in herniation of the pouch of
Douglas. It may contain omentum or even gut and
hence called enterocele.
 Secondary vault prolapse – this may occur following
either vaginal or abdominal hysterectomy. Undetected
enterocele during initial operation or inadequate primary repair
usually results in secondary vault prolapse.
4. explain about  Uterine prolapse: Explains Listens LCD How uterine prolapse
uterine prolapse. occur?
 The descent of the uterus and the vagina from its normal
position is known as prolapse.
There are two types.
Utero vaginal -- This is the commonest type. Cystocele
occurs first followed by traction effect on the cervix
causing retroversion of the uterus. Intra-abdominal pressure has got
piston like action on the uterus thereby pushing it down
into the vagina.
Congenital --- There is usually no cystocele. The uterus
herniates down along with inverted upper vagina. This is
often met in nulliparous women and hence called
nulliparous prolapse. The cause is congenital weakness
of the supporting structures holding the uterus in
5. state down the position. Explains Listens LCD What are the etiology of uter
etiology of Etiology : prolapse?
uterine prolapse. Injury during child birth is generally implicated as the most
important factor, but sufficient emphasis must also be given
to musculofascial atony which occurs and increases after
menopause.

Predisposing factor:
a) Congenital or developmental weakness of the support of the
uterus.
b) Acquired
 childbirth injuries
  Inadequate puerperal rehabilitation
 Rapid succession of pregnancies
 Atrophy of supporting tissues
 Poor abdominal musculature

6. list out the Degrees of uterine prolapse: Explains Listens LCD What are the degrees
degrees of  First degree uterine prolapse?
uterine prolapse.  Second degree
 Third degree
7. describe the Symptoms: Explains Listens LCD What are the
symptoms of  Discomfort symptoms of uterine
uterine prolapse?  Discharge prolapse?

 Backache
 Urinary symptoms
 Rectal symptoms.

8. describe the Clinical examination and diagnosis: Explains Listens Black What are the clinical
clinical  Inspection board examination and
examination and  Vaginal examination diagnosis of uterine
diagnosis of  Rectal examination prolapse?
uterine prolapse  Recto-vaginal examination
 A negative finding on inspection in dorsal position should be
reconfirmed by asking the patient to strain on squatting position.
 Prolapse of one organ is usually associated with prolapse of the
adjacent organs.
  Cystocele
 Cysto-urethrocele
 Relaxed perineum
 Rectocele and enterocele
 Uterine prolapse , second and third degree.

9. Enumerate the Treatment: Explains Listens LCD What are the

treatment of  Preventive preventive measures
uterine prolapse?  Conservative of uterine prolapse?
 Surgery
 Preventive
Effective ante-natal care
Adequate intra-natal care
Adequate post-natal care
General measures
 Conservative:
 Assurance
 Improvement of nutritional status
 Pelvic floor exercises in an attempt to strengthen
the muscles.
 Pessary
Surgery:
 Anterior colporrhaphy
 Colpoperineorrhaphy
 Repair of enterocele
 Pelvic floor repair (PFR)
 Fothergill’s operation
 Vaginal hysterectomy with PFR
  Repair of vault prolapse
 Le fort operation

SUMMARY:

Genital prolapse is one of the common clinical conditions. The genital prolapse occurs due to weakness of
the structures supporting the organs in position. The factors are grouped as predisposing, aggravating. Clinical
type of genital prolapse include vaginal prolapse and uterine prolapse. Sign and symptoms of uterine prolapse
includes discomfort, discharge, backache, urinary symptoms, rectal symptoms. Clinical examination and diagnosis ,Inspection, Vaginal examination,
Rectal examination, Recto-vaginal examination , a negative finding on inspection in dorsal position should be reconfirmed by asking the patient to strain on
squatting position , prolapse of one organ is usually associated with prolapse of the adjacent organs. Treatment include preventive , conservative and
Surgery .

CONCLUSION:
At the end of the class the student have gain knowledge about genital prolapse .
RECAPITULATION
1) Define genital prolapse?
2) what is the aetiological factor of genital prolapse ?
3)what is uterine prolapse ?
4) Explain the sign and symptoms of uterine prolapse ?
5)What are the preventive measures of uterine prolapse ?

BIBLIOGRAPHY
1) D.C Dutta “Text book of Obstetrics” 2004 6th edition , Calcutta New central agency private limited page
no:-164-170

2)Margaret and Diane “Myles text book for Midwives” 14 th edition .China .Churchill Livingstone publishers
page no164-189

3)Mudaliar and Menons Clinical Obstetrics 1992:9th edition Madras :Logman Ltd page no 160-168

4)Helen Varney “Nurse Midwifery”2001-2nd edition Massahustte Jones and Bartlet publication page no 68-
72
.
 BIBLIOGRAPHY:

1. D.C Dutta “ TEXT BOOK OF GYNAECOLOGY” 5th edition, 2008, new central book agency “ Pvt Ltd,

p – 190 - 209
2. Mr. Sunil kumar “ Materna health problems and nursing intervention” indira Gandhi national open

university , p – 59 - 61.
3. Pilliteri “ MATERNAL AND CHILD HEALTH NURSING” 3rd edition, lipincott publication, p – 235.
4. Shaw ‘s “TEXT BOOK OF GYNAECOLOGY “ 13th edition, 2004, Elsevier publication p- 317-319 .
5. Medscape Nursing Journal 2010 Sep. Vol V