title: Oestrogen-soaked vaginal packing for decubitus ulcer in advanced pelvic organ prolapse: a case series.
abstract: BACKGROUND
  Cervicovaginal decubitus ulceration is a well-known complication of advanced pelvic organ prolapse (POP). There is no consensus for its management. This case series describes the outcome of using repeated vaginal packs soaked with oestrogen cream to reduce POP and promote decubitus ulcer healing. We aimed to investigate the speed of ulcer healing and endometrial safety with this regimen.
  
  
  METHODS
  This was a retrospective study of patients with stage 3 or 4 POP and intact uterus with decubitus ulcer who were planned for surgery that included hysterectomy after ulcer healing. Vaginal packs are replaced at least biweekly-or more frequently if extruded-until ulcer resolution.
  
  
  RESULTS
  Thirteen patients were studied. Mean age was 69 ± 6 years and mean duration of menopause was 19 ± 6 years. Nine patients had a single ulcer and four had multiple ulcers. Mean ulcer diameter was 2.8 ± 1.5 cm and mean duration for ulcer healing was 26 ± 14 days. Hysterectomy and pelvic floor reconstruction was performed a median of 5 (range 0-153) days after ulcer healing was first noted. Histopathological examination of the endometrium following hysterectomy showed three specimens with endocervical hyperplasia; one had concurrent proliferative endometrium, two had simple endometrial hyperplasia and another two had proliferative endometrium.
  
  
  CONCLUSIONS
  Oestrogen-soaked vaginal packing is a viable option for managing a decubitus ulcer in advanced POP. We document a measurable impact on the endometrium with this short-term preoperative regimen. Further research is needed to evaluate its efficacy in promoting ulcer healing and endometrial safety.
authors.affiliation: Discipline of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia. bahiyah@salam.uitm.edu.my.|Maternofetal and Embryo (MatE) Research Group, Health and Wellbeing CoRe, Universiti Teknologi MARA (UiTM), 40450, Shah Alam, Selangor, Malaysia. bahiyah@salam.uitm.edu.my.
authors.forename: Bahiyah
authors.identifier: http://orcid.org/0000-0002-6102-8344
authors.initials: B
authors.lastname: Abdullah
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Su Yen
authors.initials: SY
authors.lastname: Khong
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Peng Chiong
authors.initials: PC
authors.lastname: Tan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004717:Endometrium / Q000187:drug effects*; D004967:Estrogens / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000150:complications*; D003668:Pressure Ulcer / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D004967:Estrogens
keywords: Decubitus ulcer; Uterovaginal prolapse; Vaginal packing