Cervical elongation and prolapse during third-trimester pregnancy and labor: a case report

Prolapse with elongation of the cervix is a rare complication of pregnancy and has an estimated incidence of 1 in 10,000–15,000 deliveries. The complications of cervical prolapse during pregnancy include minor cervical desiccation and ulceration, preterm labor and delivery, and maternal sepsis and death. It may develop initially during pregnancy, but in the majority of cases, pregnancy is superimposed on a preexisting prolapse. Non-severe degree preexisting cervical prolapse resolves spontaneously in second-trimester pregnancies when the uterus becomes an abdominal organ. In such cases, it recurs in the third-trimester pregnancy. If it occurs for the first time during pregnancy it usually occurs in the third trimester and disappears after labor and delivery. A 26-year-old gravida-II, para-I Ethiopian woman initially came at gestational age of 31 weeks and 4 days with a complaint of lump protrusion per vagina for 1 day which occurred suddenly. It increased in size while standing and decreased while lying supine. She was managed with bed rest, the Trendelenburg position, and topical application of magnesium sulfate solution at the hospital and discharged home after 6 days of hospital stay with advice. She experienced preterm labor 2 weeks after discharge, at gestational age of 34 weeks and 3 days. After admission to the delivery room, she developed massive vaginal bleeding secondary to abruptio placentae which resulted in a cesarean delivery. She delivered 2.1 kg of live female neonate via cesarean delivery, and the surgery was uneventful. She had stable vital signs and good wound healing. The prolapse resolved spontaneously at 2 weeks post-operative examination. Pelvic organ prolapse during pregnancy and delivery may be associated with significant maternal and neonatal morbidity if not managed appropriately. It may resolve spontaneously after delivery without further intervention which was supported by the finding in our case. However, further follow-up is needed to report on the long-term prognosis of this kind of case.