The POP-Q (Pelvic Organ Prolapse Quantification) system measures six vaginal wall landmarks. A patient has the following measurements: Aa +2, Ba +3, C -1, Ap -1, Bp -1, D -5, TVL 9, GH 4, PB 3. What is the POP-Q Stage?
- A Stage III — leading edge >1 cm past the hymen but ≤(TVL−2) cm ✓
- B Stage II — leading edge 1 cm inside the hymen
- C Stage IV — complete eversion (total vault prolapse)
- D Stage II — leading edge at the level of the hymen
Correct answer: A. Stage III — leading edge >1 cm past the hymen but ≤(TVL−2) cm
Explanation
POP-Q staging is based on the most distal prolapse point: here Ba = +3 cm (3 cm beyond the hymen). Stage I: most distal point >−1 cm. Stage II: within 1 cm above (−1) to 1 cm below (+1) the hymen. Stage III: >+1 cm beyond hymen but ≤ TVL−2 cm (TVL−2 = 9−2 = 7 cm). Ba +3 is beyond the hymen by more than 1 cm but less than TVL−2 = 7 cm, classifying as Stage III. Stage IV would require the leading edge ≥ TVL−2 = 7 cm beyond the hymen.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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