How can a woman with cervical prolapse achieve pregnancy?

Achievement of Pregnancy with Cervical Prolapse

Women with cervical prolapse who desire pregnancy should first undergo conservative management with pessary placement to reduce the prolapse, followed by timed intercourse or assisted reproductive techniques once anatomical correction is achieved. 1, 2

Initial Assessment and Optimization

Before attempting conception, women with cervical prolapse require comprehensive evaluation to determine the severity and optimal management strategy:

• Assess prolapse severity using the Pelvic Organ Prolapse Quantification (POPQ) system to guide treatment decisions 3
• Evaluate for underlying risk factors including prior vaginal deliveries, connective tissue disorders, chronic increased intra-abdominal pressure, and obesity 4
• Screen for concurrent conditions such as urinary tract infections, cervical ulceration, or vaginal infections that may impair fertility 1, 4

Conservative Management Strategy

Pessary placement is the primary conservative approach for women with cervical prolapse attempting conception:

• Gellhorn pessary is the preferred device for reducing prolapse and maintaining anatomical position during conception attempts 1
• Pessaries protect the cervix, improve symptoms, and allow for normal conception without surgical intervention 2
• Manual reduction of the prolapsed uterus combined with lifestyle modifications (avoiding heavy lifting, managing constipation) supports pessary effectiveness 5

Fertility Considerations

Once prolapse is adequately managed, standard fertility principles apply:

• Regular unprotected intercourse every 1-2 days beginning after menstrual period ends increases likelihood of conception 6
• Women should be counseled that infertility evaluation is warranted after 12 months of regular unprotected intercourse, or after 6 months if age >35 years or other risk factors exist 6
• The pessary does not need to be removed for intercourse in most cases, though this should be individualized based on comfort and pessary type 1

Management During Early Pregnancy

If pregnancy is achieved, prolapse that existed before conception typically resolves spontaneously by the end of the second trimester without complications 2:

• Continue pessary use throughout pregnancy if needed for symptom control and to minimize gestational risks 1
• Antenatal corticosteroids at 32 weeks should be administered due to increased risk of preterm delivery 1
• Close monitoring for complications including urinary tract infections, acute urinary retention, cervical ulceration, and preterm labor is essential 2, 4

Important Caveats

Surgical correction of prolapse should generally be deferred until after childbearing is complete, as pregnancy and vaginal delivery may cause recurrence 4, 3:

• Prolapse usually persists or recurs after labor, making definitive surgical repair more appropriate after family completion 2
• Conservative management throughout pregnancy is sufficient to achieve uneventful pregnancy and delivery in most cases 4
• There is no contraindication to vaginal delivery with managed prolapse; cesarean section is reserved for obstetric indications 1

When Conservative Management Fails

If pessary placement is unsuccessful or prolapse prevents conception:

• Referral to reproductive endocrinology for assisted reproductive technologies (intrauterine insemination or in vitro fertilization) may bypass anatomical barriers 6
• Temporary surgical reduction may be considered in severe cases, though data supporting this approach during reproductive years is limited 4