••• Chapter 26^ Benign Disorders of the Upper Genital Tract^259
❍ How is POP staged according to the ordinal staging system?
Stage 0: No prolapse is demonstrated. Points Aa, Ap, Ba, and Bp are all at –3 cm and either point C or D is
between –TVL cm and –(TVL-2) cm.
Stage I: The criteria for stage 0 are not met, but the most distal portion of the prolapse is >1 cm above the level of
the hymen.
Stage II: The most distal portion of the prolapse is ≤1 cm proximal to or distal to the plane of the hymen.
Stage III: The most distal portion of the prolapse is >1 cm below the plane of the hymen but protrudes no further
than 2 cm less than the TVL in centimeters.
Stage IV: Essentially, complete eversion of the total length of the lower genital tract is demonstrated. The distal
portion of the prolapse protrudes to at least +(TVL-2) cm. In most instances, the leading edge of stage IV
prolapse will be the cervix or vaginal cuff scar.
❍ What is an alternative system to the POPQ for grading pelvic organ prolapse?
Baden-Walker system—Grade 0–4.
Grade 0—No descent.
Grade 1—Descent halfway to introitus.
Grade 2—Descent to the introitus.
Grade 3—Descent halfway past the introitus.
Grade 4—Maximum possible descent.
❍ How common is POP?
The Women’s Health Initiative found that in women with a uterus 14% had uterine prolapse, 34% had a
cystocele, and 19% had a rectocele. In women who had undergone hysterectomy, 33% had a cystocele and
18% had a rectocele.
❍ What factors are strongly associated with an increased risk of POP?
Increased parity and obesity. Race also seems to play a role, as African American women have the lowest rates of
POP, while Hispanic women have the highest rates.
❍ What is the course of the ascending limb of the uterine artery?
It courses below the fallopian tube and eventually anastomoses with the ovarian artery.
❍ What are Mackenrodt ligaments?
Also known as the cardinal ligaments, these are transverse fibrous bands that attach to the uterine cervix and to the
vault of the lateral vaginal fornix, serving to stabilize the cervix.
❍ What three structures form the boundaries of the broad ligament?
(1) The fold of peritoneum over the fallopian tube, (2) the infundibulopelvic vessels, and (3) the cardinal
ligaments.
❍ What is the embryologic origin of the fallopian tube?
Paramesonephric duct.