In the POPQ (Pelvic Organ Prolapse Quantification) system, a patient has the following measurements: Aa +2, Ba +4, C +1, D +0, Ap -2, Bp -2, Gh 4.5, Pb 2.0, TVL 8.0. What is the POPQ stage?

• A Stage IV — complete or near-complete eversion as point Ba equals TVL
• B Stage II — leading edge is within 1 cm above or below the hymen
• C Stage I — leading edge >1 cm above the hymen level
• D Stage III — leading edge of prolapse is between 1 cm distal to hymen and (TVL-2) cm; here Ba +4 is beyond +1 cm from hymen and within TVL-2 (6) ✓

Explanation

POPQ stages are based on the most distal point of prolapse: Stage 0: no prolapse; Stage I: >1 cm above hymen; Stage II: -1 to +1 cm from hymen; Stage III: >1 cm below hymen but TVL-2 cm not reached; Stage IV: complete eversion ≥TVL-2 cm. In this patient, the leading point is Ba = +4 cm (anterior vaginal wall). TVL = 8.0, so TVL-2 = 6.0. Since Ba = +4 (which is >+1 but <TVL-2 = 6), this is Stage III prolapse. C = +1 (cervix at hymen), and Aa = +2. The leading edge Ba = +4 determines the stage. Stage IV would require Ba ≥ +6 (TVL-2).

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.