Match List I with List II and select the correct answer using the code given below the lists :| List I
(Degree of uterine prolapse) | List II
(Clinical
feature of
prolapse) A. First degree
B. Second degree
C. Third degree
D. Procidentia |

1. Uterus prolapses with eversion of entire vagina
   2. The uterine cervix, body and the fundus descends outside the introitus
   3. The external os protrudes outside the vaginal introitus but uterine body still remains inside the vagina
   4. Uterus descends down from its normal anatomical position but the external os remains above the introitus |

1. A

   A-4, B-3, C-2, D-1

2. B

   A-4, B-2, C-3, D-1

3. C

   A-1, B-3, C-2, D-4

4. D

   A-1, B-2, C-3, D-4

Appeared in: ESIC Nursing Officer-7July 2024

Explanation

Listen in Hindi

• First-degree prolapse is the mildest form, where the uterus descends into the upper vagina, but the cervix does not reach the introitus.
• In second-degree prolapse, the cervix descends to or protrudes through the introitus, especially on straining, but the body of the uterus remains inside the vagina.
• Third-degree prolapse involves the descent of the entire uterus (cervix and body) outside the introitus.
• Procidentia, also known as complete or fourth-degree prolapse, is the most severe stage where the entire uterus is outside the introitus, accompanied by the eversion (turning inside out) of the vagina.

Why Other Options Were Wrong

• Option B: This option incorrectly matches second-degree prolapse with the feature of third-degree (uterine body descends outside) and third-degree prolapse with the feature of second-degree (only cervix protrudes).
• Option C: This option incorrectly matches first-degree prolapse with the feature of procidentia (complete vaginal eversion) and procidentia with the feature of first-degree prolapse (uterus remains high in the vagina).
• Option D: This option contains multiple incorrect pairings, such as matching first-degree prolapse with procidentia's feature and second-degree with third-degree's feature.

Related Visual

• Visual 1: Diagram - A series of four illustrations showing the sagittal view of the female pelvis, demonstrating the progressive descent of the uterus from its normal position through first, second, third-degree prolapse, and finally procidentia. This helps visualize the relationship between the cervix and the vaginal introitus at each stage.

Clinical Relevance

• Nursing practice connection: Knowing Clinical grading and features of uterine prolapse helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Nurses must accurately assess and document the degree of uterine prolapse to inform the healthcare team and plan appropriate care. This includes patient education on symptoms, management options (like pessaries or Kegel exercises), and pre- and post-operative care.
• The severity of prolapse directly impacts the patient's quality of life, causing symptoms like pelvic pressure, urinary incontinence or retention, bowel problems, and sexual dysfunction. Nursing care focuses on managing these symptoms and providing emotional support.
• What if? If a patient with third-degree prolapse presents with a bleeding, ulcerated mass on the cervix, the nurse should recognize this as a decubitus ulcer. This complication arises from chronic exposure and friction. Immediate management involves reducing the prolapse if possible, applying local estrogen cream to improve tissue health, and preparing the patient for definitive surgical repair.

How to Approach the Question

• First, understand that this is a 'Match the Following' question. Your goal is to correctly pair each item in List I with its corresponding description in List II.
• Identify the core concept: the clinical grading of uterine prolapse.
• Recall the key anatomical landmark for grading: the vaginal introitus (the opening of the vagina). The grade is determined by how far the uterus has descended relative to this point.
• Systematically define each degree. Start with the mildest (First degree) and progress to the most severe (Procidentia).
• Match A (First degree) with its definition in List II. Then match B (Second degree), and so on.
• Once you have matched all four items (A-4, B-3, C-2, D-1), find the option that lists this correct combination.

Concept Tested & Keywords

• Concept Tested: Clinical grading and features of uterine prolapse
• Stem keywords: Uterine prolapse, First degree, Second degree, Third degree, Procidentia, Clinical feature
• Lead-in keywords: Match, select the correct answer
• Clinical cues: The position of the cervix (external os) relative to the vaginal introitus is the primary determinant for grading.
• Clinical cues: Procidentia is the most severe form, involving complete uterine descent and vaginal eversion.

Question ID

Q76H15Af2dVbiQVxbHLMlE

Copy ID