The POP-Q (Pelvic Organ Prolapse Quantification) system uses six points relative to the hymenal ring. A woman has Aa = +1, Ba = +3, C = +4, D = +3, Ap = −1, Bp = −1, TVL = 9, GH = 4, PB = 3. Which stage of prolapse does she have?

• A Stage I — leading edge 1 cm above the hymen
• B Stage II — leading edge within 1 cm of hymen (above or below)
• C Stage III — leading edge >1 cm below the hymen but not completely everted ✓
• D Stage IV — complete eversion or near-complete eversion

Explanation

POP-Q staging is determined by the most distal prolapsing structure. The leading edge is the most distal point value. In this patient, the highest positive value is C = +4 (cervix at 4 cm below the hymenal ring). Stage criteria: Stage I = leading edge >1 cm above hymen (negative), Stage II = leading edge ≤1 cm above or ≤1 cm below hymen (−1 to +1), Stage III = leading edge >1 cm below hymen but not completely everted (> +1 and < TVL−2; TVL−2 = 9−2 = 7 cm), Stage IV = leading edge ≥ TVL−2 cm (≥7 cm). C = +4, which is >+1 and <7 cm, placing this in Stage III.

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

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Written and medically reviewed by the StethoPrep medical team.