Cervical prolapse during pregnancy.

The occurrence of cervical prolapse during pregnancy is uncommon. Fewer than 245 cases have been reported in the literature, and only 5 have been reported since 1968.3 Most cases were reported before 1900. In 1941 Keettel reported only 1 case in 13,000 deliveries, and in 1944 KibeI reported a ratio of 1 in 15,696 deliveries. The incidence of uterine prolapse in India is much more common, estimated to be as high as 1 in 547 deliveries. There have been no cases of uterine prolapse reported in the family practice literature. The reported complications that result from cervical prolapse during pregnancy have ranged from minor cervical desiccation and ulceration to devastating maternal fatalities. The scope of complications includes, but is not limited to, spontaneous abortion, preterm labor, premature delivery, fetal demise, and maternal sepsis. Keettel reported 14 cases of maternal sepsis with 8 deaths, the last of which occurred in 1925. With the advent of aseptic technique and antibiotics, the severity of maternal morbidity and rate of death have greatly diminished. Even so, KeetteI and Piver and Spezia,8 whose observations are separated by 27 years, reported similar rates of fetal death at 18.1 % and 18.2%, respectively. Patient discomfort, urinary tract infection, acute urinary retention, premature labor, and prenatal loss remain serious risks.7 Given that cervical prolapse is rare and has yet to be reported in the family practice literature, we have set out to cite a case and describe a rational, conservative approach to treatment that a family physician, with available obstetric backup, would feel comfortable practicing.