A rare case of procidentia with rectal prolapse: A revolutionary change needed in the delivery practices in rural India

Authors : Dhwani Mehta, Charmi Pawani, Nimish Pandya

DOI : 10.18231/2394-2754.2019.0028

Volume : 6

Issue : 1

Year : 2019

Page No : 116-118

Witnessing Multigravida, Grand Multigravida and Great Grand multigravida pregnancy is very usual and common in the Kacchch district of Gujarat, India. Kachchh happens to be the largest District of India with majority of population living in the rural area who are illiterate and believe in the norm of “Home delivery: Safe delivery”. In the era of 20^th century where a majority of us are happy with normal labour conducted by a skilful obstetrician at the hospital with the simultaneous assessment by the paediatrician there occurs a significant population nesting in rural corners who still abide by the traditional birth practices with “The Normal Dia Labour” unaware of its aftermath. A 59 year old, Widow, Female Patient P5L2D3 with all full term normal vaginal delivery conducted at Home presented to G.K. General Hospital (the only tertiary referral centre in the entire district) with inability to pass urine and with something coming out per vaginum. On examination it was a case if long standing procidentia with decubitus ulcer with purulent exudation and simultaneous contamination of it with pus and faecal matter from the surrounding rectal prolapse. Surgical correction by vaginal hysterectomy and repair of rectal prolapse was done with building up of perineum - a surgery which was a difficult nut to crack for the Gynaecologists and Surgeons. With increased parity and poor interval spacing with improper perineal support during the labour, the perineum becomes lax and the ligament and supports of the uterus become asthenic, flaccid. This shall present with pelvic organ prolapse in the peri-menopausal age, menopausal and post-menopausal age group. The ladies in the rural Indian setting believe it to be a social stigmata and thus rarely these cases reach the hospital for intervention.

Keywords: Multigravida, Procidentia, Rectal prolpase, Decubitus ulcer, Cystocoele, Vaginal hysterectomy, Perineum.

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