What should be done if the uterus prolapses 15 days postpartum?

Immediate Emergency Management of Postpartum Uterine Prolapse

A uterus prolapsing 15 days after delivery requires urgent gynecologic evaluation and immediate conservative management with bed rest, pelvic support (pessary), and preparation for potential surgical intervention if conservative measures fail.

Immediate Assessment and Stabilization

This is a rare but serious postpartum complication requiring prompt recognition and management 1. The patient needs:

• Immediate gynecologic consultation for assessment of prolapse severity and associated complications 1
• Evaluation for acute urinary retention, which is a common complication of postpartum uterine prolapse 1
• Assessment for signs of infection, including cervical infection or endometritis, as the prolapsed tissue is exposed and vulnerable 1, 2
• Examination for concurrent hemorrhage, as postpartum patients remain at risk for bleeding complications 3

Initial Conservative Management

First-line treatment should be conservative unless there are complications requiring immediate surgical intervention 1:

• Bed rest with Trendelenburg positioning (head down, pelvis elevated) to reduce the prolapse 1
• Manual reduction of the prolapsed uterus followed by placement of a vaginal pessary to maintain position 1
• Bladder catheterization if urinary retention is present, which is common with uterine prolapse 1
• Antibiotic coverage if there are signs of infection or tissue compromise 2

The goal during the postpartum period is to achieve conservative management throughout the puerperium, as many cases can be managed successfully without surgery if treated appropriately according to severity 1.

Monitoring for Complications

Vigilant monitoring is essential as postpartum uterine prolapse can lead to serious complications 1:

• Cervical ulceration or necrosis from prolonged exposure and trauma
• Urinary tract infections secondary to urinary retention or incomplete bladder emptying 1
• Risk of preterm labor if the patient were to become pregnant again (though unlikely at 15 days postpartum)
• Potential for acute hemorrhage if tissue becomes compromised 3

Surgical Intervention Criteria

Surgery should be considered if 1, 4:

• Conservative management fails to maintain reduction
• Severe tissue compromise or necrosis develops
• Persistent urinary retention despite catheterization
• Patient develops signs of sepsis or severe infection

Surgical options include uterine suspension procedures or, in severe cases with tissue necrosis, hysterectomy may be necessary 4.

Common Pitfalls to Avoid

• Delaying gynecologic consultation can lead to tissue compromise and increased morbidity 1
• Failing to assess for urinary retention is a critical oversight, as this is one of the most common complications 1
• Attempting immediate surgical correction without trying conservative measures first is unnecessarily aggressive for most cases 1
• Inadequate follow-up planning after initial stabilization, as these patients require close monitoring throughout the postpartum period 4

Definitive Management Planning

Once the acute situation is stabilized, long-term management should be planned 4:

• Most postpartum uterine prolapse cases can be managed conservatively during the puerperium with pessary support 1
• Definitive surgical correction, if needed, should be delayed until at least 6-12 months postpartum when tissue healing is complete and the patient's family planning is clarified 4
• Pelvic floor physical therapy should be initiated once acute complications resolve 5