Key topics for improving POP care Nepal

Questions increase as more experience is gained. Some of these are:

POP prevalence

. more POP in (rural) Nepal? Relation to ethnicity, genetic aspects?

. more POP in lower casts?

. more POP in Terai than in hilly area of Nepal?

. is a retroverted uterus a factor in developing POP?¹

POP severity

. more POP 3 – POP 4 in Nepal than in western countries?

. are there mortality figures in women with POP 3 – POP 4?

Contributing factors

. what is the role of age at first childbirth and development of POP?

. what is the role of specific aspects like heavy lifting

Prevention of POP

. what is the place of pelvic floor exercises in women with and without POP?

. how to measure the effect of preventive measures?

Treatment of POP

. what is a positive result for a woman?

. can POP stage diminish through pessary treatment?

. is there a place for pelvic floor exercises?

. what is the effect of pelvic floor exercises in women with a good/bad pelvic floor

. what is the result of pessary treatment after 1 year, after 2 years, after 5 years?

. what are the reasons to stop pessary treatment after successful fitting

. what is the recurrence rate of POP surgery in cases with Anterior Repair?

. what is the recurrence rate of POP surgery in cases with Vaginal hysterectomy?

. what are the results of different surgical interventions for vault prolapse?

. is carrying heavy loads a factor in developing a (vault) prolapse?

. is squatting a factor in developing a (vault) prolapse?

Other items

. the development of a questionnaire about POP validated for women in rural Nepal ²