Systematic classification of uterine cervical elongation in patients with pelvic organ prolapse

• Published in: European journal of obstetrics & gynecology and reproductive biology 2016-05, Vol.200, p.40-44
• Main Authors: Mothes, Anke R, Mothes, Henning, Fröber, Rosemarie, Radosa, Marc P, Runnebaum, Ingo B
• Format: Article
• Language: English
• Subjects: Aged; Case-Control Studies; Cervix Uteri - pathology; Female; Humans; Hysterectomy, Vaginal; Middle Aged; Obstetrics and Gynecology; Pelvic organ prolapse; Pelvic Organ Prolapse - pathology; Pelvic Organ Prolapse - surgery; Postoperative Complications; Prolapse hysterectomy; Retrospective Studies; Uterine cervical elongation; Uterine corpus/cervix ratio; Uterus - pathology
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2016.02.029

Abstract Objective To define and classify cervical elongation, to compare uterine measurements after prolapse hysterectomy with a non-prolapse control group, and to associate stage of prolapse and degree of cervical elongation. Study design This was a single-centre retrospective case-control study conducted at the University Hospital, Urogynaecological Unit, with a certified urogynaecological surgeon. Data were collected from patients with and without pelvic organ prolapse (POP) who underwent laparoscopically assisted vaginal hysterectomy. Post-hysterectomy uterine cervical elongation was examined using the corpus/cervix ratio (CCR), calculated from measurements taken on photographs. Cervical elongation was classified as physiological (grade 0, CCR > 1.5) grade I (CCR > 1 and ≤1.5) grade II (CCR > 0.5 and ≤1), and grade III (CCR ≤ 0.5). Results Cervical elongation was detected in 288/295 (97.6%) patients in the prolapse group (grade I, 44/288 [15.2%]; grade II, 212 [73.6%]; grade III, 32 [11.1%]). Mean CCR was greater among those with stage II/III than among those with stage IV prolapse (1.0 ± 0.4 vs . 0.8 ± 0.2; p < 0.001). Grades of cervical elongation and prolapse stages were associated ( p < 0.001). Grade I cervical elongation was detected in 26/69 (37.6%), grade II in 5/69, and grade III in 0/69 patients of the control group. Cervical elongation was found more often in the prolapse group compared to the control group ( p < 0.001). Mean total uterine length did not differ between the prolapse and control groups (8.0 ± 1.6 vs . 8.2 ± 1.3 cm), but mean calculated cervical length was greater in the prolapse group than in the control group (4.4 ± 1.1 vs. 3.1 + 0.8 cm; p < 0.0001). Conclusions Uterine cervical elongation is found in patients undergoing hysterectomy for pelvic organ prolapse. Cervical elongation grades and prolapse stages are correlated. Defining uterine cervical elongation based on corpus/cervix ratio with grades I–III could be a valuable basic tool for further research.