258 Obstetrics and Gynecology Board Review •••
❍ How should physical examination be performed when using the POPQ system?
The patient should be standing and performing a Valsalva maneuver to elicit maximum prolapse.
❍ What is the vaginal reference point for POPQ scoring?
Hymen.
The following questions relate to POPQ.
❍ Define point Aa.
A point located in the midline of the anterior vaginal wall 3 cm proximal to the external urethral meatus; the
position of point Aa relative to the hymen can range from -3 to +3 cm.
❍ Define point Ba.
Ba represents the most distal position of any part of the upper anterior vaginal wall from the vaginal cuff or
anterior vaginal fornix to point Aa. By definition, point Ba is at -3 cm in the absence of prolapse.
❍ Define point C.
C represents either the most distal (ie, most dependent) edge of the cervix or the leading edge of the vaginal cuff
after total hysterectomy.
❍ Define point D.
Point D represents the location of the posterior fornix (or pouch of Douglas) in a woman who still has a cervix.
Point D is omitted in the absence of the cervix.
❍ Define point Bp.
Point Bp is the most distal position of any part of the upper posterior vaginal wall from the vaginal cuff or
posterior vaginal fornix to point Ap. By definition, point Bp is at –3 cm in the absence of prolapse.
❍ Define point Ap.
A point located in the midline of the posterior vaginal wall 3 cm proximal to the hymen. By definition, the range
of position of point Ap relative to the hymen is –3 (normal) to +3 cm (complete prolapse).
❍ What other landmarks are used in the POPQ 3 ¥ 3 grid?
Genital hiatus (gh): Measured from the middle of the external urethral meatus to the posterior midline hymen.
Perineal body (pb): Measured from the posterior margin of the genital hiatus to the midanal opening.
Total vaginal length (TVL) is the greatest depth of the vagina in centimeters when point C or D is reduced to its
full normal position.