EP13.06: Maternal death: final outcome of pre‐existing severe pelvic organ prolapse in pregnancy as a case report

Pelvic organ prolapse rarely occur in pregnancy and can complicate the pregnancy. A woman with preexisting prolapsed uterus (stage 3) and her follow up are presented here. There is a case of a 43-years old G4P3A1L2D1 (all NVD) woman with history of uterine prolapse during previous pregnancy. In previous pregnancy she was referred due to urinary retention and uterine prolapse was diagnosed. Before management of preexisting POP she became pregnant. Her Body Mass Index (BMI) was 22 kg/m2. She was an academician not require heavy-lifting work which may increase the risk of POP. At 17th weeks visit, She successfully is managed by application of pessary without any complication during pregnancy (only physiological thrombocytopenia of pregnancy). Pessary was removed at 37 weeks because of on and off uterine contraction. She was delivered vaginally. Then due to vaginal bleeding and uterine rupture and laceration, unfortunately the patient expired 2hours postpartum. Management of pelvic organ prolapse during pregnancy is based on patient symptoms. If the patient has uterine prolapse before pregnancy, cervix maybe more prone to laceration and tearing due to tissue shrinkage and dryness. Therefor uterine prolapse can lead to potentially serious complications for both mother and fetus. About method of delivery, the decision must be individualised by considering possible complications. The main risks for pregnant women with POP are preterm labour, urinary retention, urinary infection, sepsis, cervical laceration, uterine rupture and even maternal death.