title: The role of apical vaginal support in the appearance of anterior and posterior vaginal prolapse.
abstract: OBJECTIVE
  To describe how simulated apical support affects the appearance of prolapse in the anterior and posterior vagina using a modification of the Pelvic Organ Prolapse Quantification (POP-Q) examination.
  
  
  METHODS
  Women with prolapse stage II or greater were examined using the POP-Q. To simulate apical support, the posterior blade of a standard Graves speculum was positioned over the posterior vagina to support the vaginal apex while remeasuring points Aa and Ba and over the anterior vagina to support the apex while remeasuring points Ap and Bp. Change in anterior and posterior POP-Q points and prolapse stage with apical support were calculated.
  
  
  RESULTS
  One hundred ninety-seven women were enrolled with mean age of 62+/-14 years, median parity of 2 (range 0-8), and mean body mass index of 28+/-5 kg/m(2). By standard POP-Q, 36% had stage II prolapse, 54% had stage III, and 10% had stage IV prolapse. With simulated apical support, point Ba changed to stage 0 or I in 55% of cases and point Bp changed to stage 0 or I in 30% (P<.001 for each point). Mean change for point Ba with apical support was 3.5+/-2.6 cm and point Bp was 1.9+/-2.9 cm (P<.001).
  
  
  CONCLUSIONS
  When the POP-Q examination is performed with simulated apical support, the critical role of level I vaginal support on the position of the anterior and posterior vagina, particularly the anterior vagina, becomes apparent.
  
  
  METHODS
  II.
authors.affiliation: Department of Obstetrics, Magee-Womens Hospital, University of Pittsburgh-School of Medicine, Pittsburgh, Pennsylvania 15213, USA. jlowder@mail.magee.edu
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Lowder
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Park
authors.forename: Rennique
authors.initials: R
authors.lastname: Ellison
authors.forename: Chiara
authors.initials: C
authors.lastname: Ghetti
authors.forename: Pamela
authors.initials: P
authors.lastname: Moalli
authors.forename: Halina
authors.initials: H
authors.lastname: Zyczynski
authors.forename: Anne M
authors.initials: AM
authors.lastname: Weber
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D012720:Severity of Illness Index; D013525:Surgical Instruments; D014596:Uterine Prolapse / Q000145:classification* / Q000503:physiopathology*; D014636:Valsalva Maneuver