Double pessary use in grade 4 uterine and vaginal prolapse.
BACKGROUND
Certain situations dictate conservative management of grade 4 uterine or vaginal vault prolapse in women. The reduction of a prolapse may not be possible if the vagina cannot retain a single pessary. We have used double pessaries in the management of this condition.


METHODS
With the patient in the dorsal lithotomy position, either a Donut or Inflatoball (Milex Products Inc., Chicago, IL) pessary is inserted and pushed into the vagina as far as is comfortable. A second pessary, either a flexible Gellhorn or Shaatz (Milex Products Inc.), then is placed caudad to the first.


RESULTS
We have used this approach in five women who have been followed for 7-15 months. There have been no erosions or vaginitis and all the women experienced symptomatic relief.


CONCLUSIONS
In women who want or require conservative management of grade 4 prolapse and are unable to retain a single pessary, the placement of two pessaries often will be successful.
Myers
D L
DL
Department of Obstetrics and Gynecology, Women and Infants' Hospital of Rhode Island, Brown University School of Medicine, Providence 02905, USA.
LaSala
C A
CA
Murphy
J A
JA
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010570:Pessaries; D013997:Time Factors; D014596:Uterine Prolapse / Q000517:prevention & control*