Editing Functional: Pelvic Organ Prolapse (section)

== Pelvic Organ Prolapse Quantification (POP-Q) system ==

* Several classification systems are used to quantify pelvic organ prolapse, the most widely used of which are the Baden-Walker classification and the Pelvic Organ Prolapse-Quantification (POP-Q) system.
* '''POP-Q'''
** See [https://pop-q.netlify.app/ Interactive Pop-Q Tool]
** '''6 defined points (Aa, Ba, C, D, Ap, Bp) and 3 other landmarks (GH, TVL, PB)'''
*** '''Each is measured in centimeters in relationship to a <span style="color:#ff0000">fixed reference point, the hymenal ring</span>'''
**** A negative number represents above or proximal to the hymen
**** A positive number represents below or distal to the hymen
**** The hymen was selected as the reference point rather the introitus because it is more precisely identified
*** '''Anterior wall (2):'''
**** '''Aa'''
***** '''Point denoting the anterior vaginal wall that is 3 cm proximal to the urethral meatus'''
****** '''Meant to estimate the position of the bladder neck/proximal urethra junction in most women.'''
***** '''Ranges from −3 cm to +3 cm (−3 cm in the absence of prolapse or urethral hypermobility).'''
**** '''Ba'''
***** '''Point denoting to the most distal portion of anterior vaginal wall prolapse''' (from the vaginal apex to point Aa).
***** '''Ranges from −3 cm to +tvl'''
*** '''Posterior wall (2)'''
**** '''Ap'''
***** '''Point denoting the posterior vaginal wall that is 3 cm proximal to the urethral meatus, meant to parallel the Aa point'''
***** '''Ranges from −3 cm to +3 cm''' (−3 cm in the absence of prolapse or urethral hypermobility).
**** '''Bp'''
***** '''Point denoting to the most distal portion of posterior vaginal wall prolapse'''
***** '''Ranges from −3 cm to +tvl'''
*** '''Apex (2):'''
**** '''C'''
***** '''Point denoting the cervix''' (or the vaginal cuff/hysterectomy scar in women without a cervix)
**** '''D'''
***** '''Point denoting the posterior fornix''' (in a woman who still has a cervix)
***** Point D, when compared to point C, will differentiate cervical elongation from uterine prolapse
*** Genital hiatus (gh)
**** Measured from the middle of the urethral meatus to the posterior midline hymen.
*** Perineal body (pb)
**** Measured from the posterior margin of the genital hiatus to the middle of anal opening.
*** Total vaginal length (tvl)
**** Greatest depth of the vagina in cm when the vagina is fully reduced (point C or D reduced to normal position).
* '''POP-Q staging'''
** '''Stages are assigned to the most severe portion of the prolapse when the full extent of the prolapse has been demonstrated with straining'''
*** Points Aa, Ba, Ap, Bp, C, and D are measured with the patient straining, so as to accentuate maximal prolapse during the examination.
** '''Stage 0: without prolapse (points Aa, Ba, Ap, Bp are all at −3, and point C or D is between −tvl and −[tvl −2]) cm.'''
** '''Stage 1: distal portion (Ba or Bp) of the prolapse is > 1 cm above the level of the hymen'''
** '''Stage 2: distal portion (Ba or Bp) of the prolapse is within 1 cm on either side of the hymen'''
** '''Stage 3: distal portion (Ba or Bp) of the prolapse is > 1 cm below the hymen but not totally everted (no further than 2 cm less than tvl)'''
** '''Stage 4: complete vaginal eversion (≥ 2 cm less than tvl)'''
** '''Asymptomatic stage 1 or 2 POP are considered normal in adult women'''