Pelvic Organ Prolapse Quantification (POP-Q) System: Difference between revisions
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The measurement parameters are made up of six distinct locations (Aa, Ba, C, D, Ap, Bp) and three anatomical markers (GH, PB, TVL): | The measurement parameters are made up of six distinct locations (Aa, Ba, C, D, Ap, Bp) and three anatomical markers (GH, PB, TVL): | ||
* Point Aa is at the midline of anterior vaginal wall. Where no prolapse is present this location is 3cm up from the hymen (merely interior to the vaginal opening). Parameters from the hymen can be -3cm indicating no anterior vaginal prolapse or +3cm which is a full prolapse. | * Point Aa is at the midline of anterior vaginal wall. Where no prolapse is present this location is 3cm up from the hymen (merely interior to the vaginal opening). Parameters from the hymen can be -3cm indicating no anterior vaginal prolapse or +3cm, which is a full prolapse. | ||
* Point Ba refers to the most superior location of the front vaginal wall . This location coexists with Aa (-3cm) in a woman with no anterior prolapse. However, in a woman with full prolapse this location coexists with point C. | * Point Ba refers to the most superior location of the front vaginal wall . This location coexists with Aa (-3cm) in a woman with no anterior prolapse. However, in a woman with full prolapse this location coexists with point C. | ||
* | * Point C is the lowest edge of the cervix or the vaginal cuff (i.e. hysterectomy scar). This location identifies if the cervix is descending. | ||
* Point D is the topmost point of the posterior vaginal wall. This location can be contrasted with Point C to assess if the entry to the cervix has been extended. | |||
* Point Ap is located midline of posterior vaginal wall 3cm proximal to hymen. The parameters for this point can range from -3cm to +3cm relative to hymen. | |||
* Point Bp is the uppermost point of the posterior vaginal wall. | |||
* GH is the 'Genital hiatus' that records the length from the urethral opening to the posterior vaginal opening/ hymen. The hiatus refers to the opening in puborectalis muscle, a component of the levator ani muscles. A larger distance here may indicate laxity in this area. | |||
* PB is the 'perineal body' and is recorded from the posterior aspect of hymen to the mid-anal opening. This will give an insight to the tonicity of superficial pelvic floor. Through vaginal birth the perineal body can be injuried via tears or by an episiotomy. | |||
* TVL refers to 'total vaginal length' measured from hymen to the most distal point<ref name=":0" />. Knowing this allows the depth of prolapse to be assessed and reassessed post surgical repair. | |||
== Evidence == | == Evidence == | ||
Revision as of 22:35, 16 September 2020
Original Editor - User Name
Top Contributors - Jacintha McGahan, Mila Andreew and Kim Jackson
Objective[edit | edit source]
The International Continence Society (ICS), the American Urogynecologic Society (AUGS) and the Society of Gynecologic Surgeons came to agreement in 1996, for a graded objective measure to be used in the assessment of female pelvic organ prolapse[1][2]. This system provides characterisation of a woman's prolapse and allows a uniform recording method to be used by clinicians that enables contrast and disclosure of findings[2]. This system was named the 'Pelvic Organ Prolapse Quantification (POP-Q) System' and is generally used in clinical setting [3]. POP-Q is the more routinely used 'staging system' seen in published research[4].
Intended Population[edit | edit source]
A woman may present in primary care with symptoms of a 'bulge' or 'heaviness' in her vagina with or without incontinence[1][5]. Other symptoms may include urge incontinence, sexual dysfunction, problems with voiding or defecation[1]. On visual inspection a prolapse may be observed but this patient group can also be asymptotic and are identified through other routine procedures, for instance a smear test[5]. A reduction in vaginal or uterine integrity is observed 'in up to 30-70%' of women presenting for usual gynaecology procedures, with 3-6% of these women reporting a drop pass the vaginal opening[6].
Method of Use[edit | edit source]
Foregoing the procedure ensure the patient has an empty bladder and if feasible an empty rectum[2]. A full bladder during this examination could risk undervaluing the POP-Q score and therefore, miscalculate the staging[7]. The patient is then positioned where the utmost magnitude of the prolapse is shown and can be confirmed by the patient[2]. Positions may include supine, standing or in a birthing chair at 45 degree angle[8]. A Sim's speculum can be used if needed to draw back the anterior and posterior vaginal walls during the examination. All methods and positions utilised during the examination should be documented so that they can be reproduced[2].
The measurement parameters are made up of six distinct locations (Aa, Ba, C, D, Ap, Bp) and three anatomical markers (GH, PB, TVL):
- Point Aa is at the midline of anterior vaginal wall. Where no prolapse is present this location is 3cm up from the hymen (merely interior to the vaginal opening). Parameters from the hymen can be -3cm indicating no anterior vaginal prolapse or +3cm, which is a full prolapse.
- Point Ba refers to the most superior location of the front vaginal wall . This location coexists with Aa (-3cm) in a woman with no anterior prolapse. However, in a woman with full prolapse this location coexists with point C.
- Point C is the lowest edge of the cervix or the vaginal cuff (i.e. hysterectomy scar). This location identifies if the cervix is descending.
- Point D is the topmost point of the posterior vaginal wall. This location can be contrasted with Point C to assess if the entry to the cervix has been extended.
- Point Ap is located midline of posterior vaginal wall 3cm proximal to hymen. The parameters for this point can range from -3cm to +3cm relative to hymen.
- Point Bp is the uppermost point of the posterior vaginal wall.
- GH is the 'Genital hiatus' that records the length from the urethral opening to the posterior vaginal opening/ hymen. The hiatus refers to the opening in puborectalis muscle, a component of the levator ani muscles. A larger distance here may indicate laxity in this area.
- PB is the 'perineal body' and is recorded from the posterior aspect of hymen to the mid-anal opening. This will give an insight to the tonicity of superficial pelvic floor. Through vaginal birth the perineal body can be injuried via tears or by an episiotomy.
- TVL refers to 'total vaginal length' measured from hymen to the most distal point[2]. Knowing this allows the depth of prolapse to be assessed and reassessed post surgical repair.
Evidence[edit | edit source]
Reliability[edit | edit source]
Validity
Responsiveness[edit | edit source]
Links[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP–Q)–a new era in pelvic prolapse staging. Journal of medicine and life. 2011 Feb 15;4(1):75.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Madhu C, Swift S, Moloney‐Geany S, Drake MJ. How to use the Pelvic Organ Prolapse Quantification (POP‐Q) system?. Neurourology and Urodynamics. 2018 Aug;37(S6):S39-43.
- ↑ Muir TW, Stepp KJ, Barber MD. Adoption of the pelvic organ prolapse quantification system in peer-reviewed literature. American journal of obstetrics and gynecology. 2003 Dec 1;189(6):1632-5.
- ↑ Boyd SS, O'Sullivan DM, Tulikangas P. 29: Implementation of the pelvic organ prolapse quantification system in peer-reviewed journals. American Journal of Obstetrics & Gynecology. 2017 Mar 1;216(3):S591.
- ↑ 5.0 5.1 Guidance NI. Urinary incontinence and pelvic organ prolapse in women: management:© NICE (2019) Urinary incontinence and pelvic organ prolapse in women: Management. BJU Int. 2019;123(5):777-803.
- ↑ Barber MD. Pelvic organ prolapse. Bmj. 2016 Jul 20;354:i3853.
- ↑ Reich A, Kohorst F, Kreienberg R, Flock F. Influence of bladder volume on pelvic organ prolapse quantification results. Gynecologic and obstetric investigation. 2010;70(2):82-6.
- ↑ Visco AG, Wei JT, McClure LA, Handa VL, Nygaard IE. Effects of examination technique modifications on pelvic organ prolapse quantification (POP-Q) results. International Urogynecology Journal. 2003 Jun 1;14(2):136-40.
