A 58-year-old multiparous woman presents with a bulge at the vaginal introitus. On examination, the leading edge of the anterior vaginal wall protrudes 2 cm beyond the hymen on maximum Valsalva; total vaginal length (TVL) is 8 cm. Using the POP-Q system, this measurement (point Ba = +2 cm) corresponds to which stage?

• A Stage II prolapse
• B Stage I prolapse
• C Stage IV prolapse
• D Stage III prolapse ✓

Explanation

POP-Q staging: Stage 0 = no descent; Stage I = leading edge > 1 cm above hymen (< −1 cm); Stage II = leading edge between −1 cm and +1 cm (inclusive) of the hymen; Stage III = leading edge > +1 cm beyond hymen but < (TVL − 2) cm; Stage IV = complete eversion (leading edge ≥ TVL − 2 cm). With Ba = +2 cm and TVL = 8 cm: TVL − 2 = 6 cm. Since +2 cm is > +1 cm (Stage III threshold) and < 6 cm (Stage IV threshold), this is Stage III. A leading edge of exactly +1 cm would still be Stage II; it must exceed +1 cm to be classified as Stage III.

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

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Written and medically reviewed by the StethoPrep medical team.