DOUBLE PESSARY USE IN GRADE-4 UTERINE AND VAGINAL PROLAPSE

Background: Certain situations dictate conservative management of grad e 4 uterine or vaginal vault prolapse in women. The reduction of a pro lapse may not be possible if the vagina cannot retain a single pessary . We have used double pessaries in the management of this condition. T echnique: With the patient in the dorsal lithotomy position, either a Donut or Inflatoball (Milex Products Inc., Chicago, IL) pessary is ins erted and pushed into the vagina as far as is comfortable. A second pe ssary, either a flexible Gellhorn or Shaatz (Milex Products Int.), the n is placed caudad to the first. Experience: We have used this approac h in five women who have been followed for 7-15 months. There have bee n no erosions or vaginitis and all the women experienced symptomatic r elief. Conclusion: In women who want or require conservative managemen t of grade 4 prolapse and are unable to retain a single pessary, the p lacement of two pessaries often will be successful. (C) 1998 by The Am erican College of Obstetricians and Gynecologists.