2 days ago I had a pelvic exam by my

Patient

Q: 2 days ago I had a pelvic exam by my OB. It was discovered (as I had thought) that I have a cystocele. I am 12 weeks pregnant (age 30) with my 4th child and also found out my uterus was retroverted (first time) and my doc felt there was a high risk of encarcerated uterus because she could feel my uterus in my vagina. She gave me a pessary to relieve symptoms from the cystocele (difficulty urinating, irritation from rubbing against underwear). Having put it in a few times now, I feel that my uterus is even lower, but also I can feel my cervix now, only about an inch deep (at my first knuckle). I have also had some spotting. My next appointment is in 4 weeks but I can't help but wonder if there is cause for concern or an explanation?? Help please!

Symptoms:  Pregnant, constipation, difficulty urinating, back pain, pelvic discomfort, mild cramping
Doctor

A:   Hi,
Thanks for the query.

I understand your concern.
Weakness of fibromuscular tissue and repeated vaginal deliveries can lead to descent of uterus. Retroverted position will favor the descent.
Increasing size of the uterus can lead to further descent.
The possible steps that can help you are:
-Instead of putting and removing the pessary, keep it in place for few weeks till uterus holds on its position.
-As you are having spotting, better to get examined. So, please do consult your doctor, get examined and go for ultrasound to monitor the well-being of the baby and to rule out abnormalities like cervical incompetence etc.

Take care.

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