A Pocket Reference Guide
Pelvic Organ
ProlapseProlapse
POP-Q ExamA Quick Reference Guide
gh
Ap
Bp
C
D
The pelvic organ prolapsequantification (POP-Q) exam is used to quantify, describe, and stage pelvic support.
There are 6 points measured at thevagina with respect to the hymen.
Points above the hymen are negative numbers; points belowthe hymen are positive numbers.
Point Description Range of ValuesAa Anterior vaginal wall 3 cm proximal to -3 cm to +3 cm
the hymenBa Most distal position of the remaining upper -3 cm to + tvl
anterior vaginal wallC Most distal edge of cervix or vaginal cuff scarD Posterior fornix (N/A if post-hysterectomy)Ap Posterior vaginal wall 3 cm proximal to -3 cm to +3 cm
the hymenBp Most distal position of the remaining upper -3 cm to + tvl
posterior vaginal wall
POP-Q Staging CriteriaStage 0 Aa, Ap, Ba, Bp = -3 cm and C or D (tvl 2) cmStage I Stage 0 criteria not met and leading edge < -1 cmStage II Leading edge -1 cm but +1 cmStage III Leading edge > +1 cm but < + (tvl 2) cmStage IV Leading edge + (tvl 2) cm
tvl
pb
GGeenniittaall hhiiaattuuss ((gghh))Measured from middle of external urethral meatus to posterior midline hymenPPeerriinneeaall bbooddyy ((ppbb))Measured from posterior margin of gh to middle of anal openingTToottaall vvaaggiinnaall lleennggtthh ((ttvvll))Depth of vagina when point D or C is reduced to normal position
Reference: Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvicorgan prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:13.
Aa
Ba
PELVIC ORGAN PROLAPSE
Pelvic Organ Prolapse
Leading edgeCervix
Leading edgeAnterior
Leading edgePosterior
Leading edgeVaginal cuff
A prolapse occurs when pelvic organs drop from their natural position and sometimes protrude. There are several different types of prolapse. Often a woman can have more than one type of prolapse
The following tabs present common types and stages of prolapse. See the inside front cover to learn more about the pelvic organ prolapse quantification (POP-Q) exam.
Uterine Prolapse Anterior Wall Prolapse
Posterior Wall Prolapse Vaginal Vault Prolapse
Uterine Prolapse
STAGE A
STAGE B
AaBa
C
D
pb
gh
Ap
Bp
tvl
-2-2
-6
-8
3
3
-2
-2
10
Aa
Ba
C
D
pb
gh
Ap
Bp
tvl
+1
+1
0
-21
4
+1
+1
10
POP-Q Measurements
Cervix
Cervix
UTERINE
AaBa
C
D
pb
gh
Ap
Bp
tvl
+3+2
+4
+1
1
5
+2
+2
10
AaBa
C
D
pb
gh
Ap
Bp
tvl
+3+5
+8
+5
1
6
+3
+5
10
STAGE C
STAGE D
POP-Q Measurements
Leading edgeCervix
Leading edgeCervix
In uterine prolapse, pelvic support structures break down and the uterus drops into the vagina. Most often, other pelvicorgans are also out of place.
AaBa
C
D
pb
gh
Ap
Bp
tvl
-2-2
-5
NA
2
3
-2
-2
9
Vaginal Vault Prolapse
STAGE A POP-Q Measurements
Vaginal cuff
AaBa
C
D
pb
gh
Ap
Bp
tvl
00
-3
NA
2
3
-1
-1
9
STAGE B
Vaginal cuff
VAGINAL VAULT
AaBa
C
D
pb
gh
Ap
Bp
tvl
+3+4
+4
NA
2
4
-1
-1
9
STAGE C POP-Q Measurements
Leading edgeVaginal cuff
AaBa
C
D
pb
gh
Ap
Bp
tvl
+3+4
+7
NA
2
5
0
0
9
STAGE D
Leading edgeVaginal cuff
For a woman who has undergone a hysterectomy, the top of the vagina (or vaginal cuff) can push into the lower vagina. This is called vaginal vault prolapse.
AaBa
C
D
pb
gh
Ap
Bp
tvl
-2-2
-5
NA
2
3
-2
-2
9
Enterocele
STAGE A POP-Q Measurements
Vaginal cuff
Small intestine
AaBa
C
D
pb
gh
Ap
Bp
tvl
00
-3
NA
2
3
-1
-1
9
STAGE B
Vaginal cuff
ENTEROCELE
AaBa
C
D
pb
gh
Ap
Bp
tvl
+2+3
+5
NA
2
4
-1
-1
9
STAGE C POP-Q Measurements
Leading edgeVaginal cuff
AaBa
C
D
pb
gh
Ap
Bp
tvl
+2+3
+7
NA
2
5
0
0
9
STAGE D
Leading edgeVaginal cuff
Women with vaginal vault prolapse often have a prolapse of the small intestine called an enterocele. In this type of enterocele, the small intestine drops through support tissue and into the vagina.
AaBa
C
D
pb
gh
Ap
Bp
tvl
-2-2
-7
-9
3
2
-2
-2
10
AaBa
C
D
pb
gh
Ap
Bp
tvl
-1-1
-5
-7
2
3
-1
-1
10
Anterior Wall Prolapse
STAGE A
STAGE B
POP-Q Measurements
Leading edgeAnterior
Leading edgeAnterior
ANTERIOR WALLwith uterus
AaBa
C
D
pb
gh
Ap
Bp
tvl
+1+2
-4
-5
3
4
-1
-1
10
STAGE C POP-Q Measurements
Leading edgeAnterior
Anterior wall prolapse (or cystocele) isthe most common type of pelvic floor defect. It occurs when the anterior wall of the vaginaloses its support. As a result, the bladder drops and rotates into, and often out of, the vaginal opening. Some cystoceles can causeurine leakage while large cystoceles can cause difficulty voiding.
AaBa
C
D
pb
gh
Ap
Bp
tvl
-2-2
-8
NA
3
3
-2
-2
9
AaBa
C
D
pb
gh
Ap
Bp
tvl
00
-6
NA
3
4
-1
-1
9
Anterior Wall Prolapse
STAGE A
STAGE B
POP-Q Measurements
Leading edgeAnterior
Leading edgeAnterior
ANTERIOR WALLwithout uterus
AaBa
C
D
pb
gh
Ap
Bp
+1+2
-4
NA
3
4
-1
-1
STAGE C POP-Q Measurements
Leading edgeAnterior tvl 9
Anterior wall prolapse (or cystocele) isthe most common type of pelvic floor defect. It occurs when the anterior wall of the vaginaloses its support. As a result, the bladder drops and rotates into, and often out of, the vaginal opening. Some cystoceles can causeurine leakage while large cystoceles can cause difficulty voiding.
AaBa
C
D
pb
gh
Ap
Bp
tvl
-3-3
-7
-9
2
3
-2
-2
10
AaBa
C
D
pb
gh
Ap
Bp
tvl
-2-2
-6
-8
2
3
0
0
10
Posterior Wall Prolapse
STAGE A
STAGE B
POP-Q Measurements
Leading edgePosterior
Leading edgePosterior
AaBa
C
D
pb
gh
Ap
Bp
tvl
-2-2
-5
-7
1
5
+3
+4
10
STAGE C POP-Q Measurements
Leading edgePosterior
A posterior wall prolapse (or rectocele)occurs when the posterior wall of the vagina loses its support. As a result, the rectum can bulge into, and often out of, the vaginal opening. A large rectocele canmake it difficult to move the bowels.
POSTERIOR WALLwith uterus
AaBa
C
D
pb
gh
Ap
Bp
tvl
-3-3
-8
NA
2
3
-2
-2
9
AaBa
C
D
pb
gh
Ap
Bp
tvl
-2-2
-7
NA
2
3
0
0
9
Posterior Wall Prolapse
STAGE A
STAGE B
POP-Q Measurements
Leading edgePosterior
Leading edgePosterior
POSTERIOR WALLwithout uterus
AaBa
C
D
pb
gh
Ap
Bp
tvl
-2-2
-6
NA
1
5
+3
+4
9
STAGE C POP-Q Measurements
Leading edgePosterior
A posterior wall prolapse (or rectocele)occurs when the posterior wall of the vagina loses its support. As a result, the rectum can bulge into, and often out of, the vaginal opening. A large rectocele canmake it difficult to move the bowels.
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