Effect of patient position on clinical evaluation of pelvic organ prolapse

Objective: To compare the severity of pelvic organ prolapse between examina tions performed in dorsal lithotomy position and examinations performed upr ight in a birthing chair using the Pelvic Organ Prolapse Quantification Sys tem (POPQ). Methods: One hundred eighty-nine consecutive women were evaluated between A pril 1997 and September 1998. All women were examined in the dorsal lithoto my position and in a birthing chair at a 45 degrees angle. Degree of pelvic organ prolapse was assessed using the POPQ. Results: When examined upright, 133 patients (70%) had the same stage of pr olapse, whereas 49 (26%) had a higher stage and seven (4%) had a lower stag e. Of patients who were stage 0 or I when examined in lithotomy position, 2 3 (36%) were stage II or greater when examined upright. Similarly, of patie nts who were stage II in lithotomy, 17 (23%) were stage III or higher when examined upright. There was a statistically significant increase in the deg ree of prolapse at all the POPQ measurements (P <.05 for each point), excep t for measurement of total vaginal length. Forty-eight percent of patients had at least one measurement increase by 2 cm or more when examined upright . Logistic regression identified no patient characteristics that were indep endently associated with a significant increase in stage or POPQ values wit h change in examination position. Conclusion: The degree of pelvic organ prolapse assessed with the patient i n the lithotomy position correlates well with assessment performed upright; however, overall there is a higher degree of prolapse with upright examina tion. (Obstet Gynecol 2000;96:18-22. (C) 2000 by The American College of Ob stetricians and Gynecologists.).