popq and popstix - iuga meeting2015.iuga.org/wp-content/uploads/workshops/ws15_hayward.pdf ·...
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POPQ and POPstix Dr Lynsey Hayward
Middlemore Hospital
Auckland
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Pelvic Organ Prolapse
• A common condition known to affect at up to 50% of parous women.
• An estimated 10% of women undergo surgery for the management of prolapse.
• In order to compare surgical outcomes and communicate with colleagues about the site and severity of prolapse we need a reliable tool eg, your medium may be my large!!
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Baden Walker halfway system
Doesn’t give good understanding of site of prolapse Not as reproducible as the POPQ Doesn’t give a measure of cervical elongation Not recommended for use by international societies Ill say no more as I may confuse!!!
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Until 1996 no standard validated system for the assessement of pelvic organ prolapse existed.
Bump et al developed the pelvic organ quantification (POP-Q) system to provide a standardised method of examination and reporting.
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The POPQ system:
• Accepted as the standard classification system of pelvic organ prolapse
• Objective, site-specific system for describing, quantifying and staging pelvic organ prolapse.
• Proven intraobserver & interobserver reliability, good reproducibility
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POPQ Significance Standardization of prolapse assessments enables:
• Effective communication among clinicians.
• Reproducible evaluation of surgical outcomes.
• Meaningful comparison of published series.
• Comparisons of different populations
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POPQ Points… don’t be scared!!!
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How to do the POPQ..
• ALL POPQ points except TVL are measured at maximum valsalva
• All points should be measured to the nearest 0.5cm
• The hymen is the key point to measure from • Minus means above the hymen • Plus means below the hymen
• Write down as you go or you will forget your recording!!
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POPstix Measuring Device
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• Start your examination by measuring TVL
• Then do points C and D
• Split the speculum to measure Aa, Ba, Ap and Bp
• Finally remove the speculum and do point Gh, and Pb
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POPQ measurements A is for anterior compartment
Aa
Ba
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POPQ measurements P is for posterior compartment
Ap
Bp
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POPQ measurements
Points C and D allow you to compare between a uterine prolapse OR an elongated cervix
If you have had a hysterectomy you have NO point D
C D
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POPQ measurements
gh pb
TVL
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The Stages
Measurements are used to stage the degree of prolapse into
four ordinal stages ranging from:
• Stage 0: no prolapse
Stage I:
• Stage II:
• Stage III:
• Stage IV: procidentia or complete vault eversion
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How to record the POPQ
Grid or illustration
Tvl C D Aa Ba Ap Bp Gh Pb Levators L/R Oxford grade Tissue quality As a list…
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Don’t examine patients for POPQ whilst asleep in theatre The patient has to be awake to do a Valsalva This a POPQ stage 4 prolapse for all compartments