title: Does pre-operative traction on the cervix approximate intra-operative uterine prolapse? A randomised controlled trial.
abstract: OBJECTIVE
  This study aims to compare pre-operative Pelvic Organ Prolapse Quantification (POP-Q) point C with and without cervical traction to that obtained intra-operatively in women undergoing pelvic organ prolapse surgery and to assess acceptability of examination with cervical traction without anaesthesia.
  
  
  METHODS
  Eighty-one women were randomised to having pre-operative examination with or without cervical traction to measure point C. Visual analogue scale (VAS) pain scores were recorded for each pre-operative examination. Comparisons were made between pre-operative and intra-operative findings.
  
  
  RESULTS
  The mean difference between pre-operative and intra-operative point C in the non-traction group was statistically higher than in the traction group (3.2 vs 1.6 cm, p = 0.0001). The level of agreement between pre-operative point C measurement with traction and intra-operative point C measurement was better than pre-operative point C measurement without traction and intra-operative point C measurement on Bland and Altman plots. Women having cervical traction reported significantly greater pain score on the VAS (3.4 vs. 1.2, p < 0.0001).
  
  
  CONCLUSIONS
  Compared to routine pre-operative examination with Valsalva and cough manoeuvres only, pre-operative examination with cervical traction had better agreement with intra-operative point C findings. Although women reported greater pain score when examined with cervical traction, it was still a tolerable and acceptable examination without anaesthesia.
authors.affiliation: Pelvic Floor Unit Southern Health, Monash Medical Centre, Moorabbin Campus, Melbourne, Victoria 3165, Australia. faylchao@yahoo.com.au
authors.forename: Fay L
authors.initials: FL
authors.lastname: Chao
authors.forename: Anna
authors.initials: A
authors.lastname: Rosamilia
authors.forename: Peter L
authors.initials: PL
authors.lastname: Dwyer
authors.forename: Alex
authors.initials: A
authors.lastname: Polyakov
authors.forename: Lore
authors.initials: L
authors.lastname: Schierlitz
authors.forename: Gerard
authors.initials: G
authors.lastname: Agnew
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000473:pathology*; D003371:Cough; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D008875:Middle Aged; D010147:Pain Measurement; D010808:Physical Examination / Q000379:methods; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D014143:Traction / Q000379:methods*; D014463:Ultrasonography; D014596:Uterine Prolapse / Q000473:pathology / Q000601:surgery*; D014636:Valsalva Maneuver