The management of an elongated cervix depends on the underlying cause, severity of symptoms, and patient preferences. Here’s an overview of management of this condition.
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1. Conservative Management
• Asymptomatic Cases: No treatment is needed if the elongated cervix is incidental and not causing issues.
• Monitoring: Regular follow-ups with pelvic exams and ultrasound if necessary.
2. Symptomatic Cases
• If associated with pelvic organ prolapse (POP)
• Pessary: A vaginal pessary can provide support and reduce symptoms.
• Pelvic Floor Exercises: Strengthening the pelvic muscles may help mild cases.
• If associated with cervical hypertrophy or elongation in young women
• Often seen in congenital conditions; typically managed conservatively unless symptomatic.
3. Surgical Management
• Cervical Amputation (Tracheloplasty)
• Indicated for significant elongation causing prolapse, dyspareunia, or hygiene issues.
• Can be done via Manchester-Fothergill procedure (preserving the uterus) or as part of a hysterectomy if prolapse is severe.
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• Hysterectomy
• Considered if the patient has uterovaginal prolapse or does not desire future fertility.
4. Special Considerations
• Pregnancy:
• If elongation is causing cervical incompetence, a cervical cerclage may be required.
• If it’s not affecting pregnancy, conservative management is preferred.
Manchester - Fothergill Operation
Indication:
• Cervical elongation causing symptoms (e.g., prolapse, hygiene issues, discomfort).
• Desire to preserve the uterus.
Procedure:
• Typically performed vaginally.
• The elongated portion of the cervix is excised.
• The remaining cervix is sutured to restore normal anatomy.
Post Manchester -Fothergil operation . The red mark is the excised portion of cervix . Trans abdominal or vaginal US can provide visual picture of the operation.
Variants:
• Manchester-Fothergill Procedure
• Suitable for cervical elongation with mild to moderate uterine prolapse.
• Involves cervical amputation, shortening of the uterosacral ligaments, and suturing to reinforce support.
• Uterus is preserved, maintaining fertility.
• Shirodkar-Trendelenburg Procedure (for pregnancy concerns)
• Involves cervical amputation with cerclage placement to prevent cervical incompetence in future pregnancies.
Postoperative Care:
• Antibiotics if needed.
• Pelvic rest for 4-6 weeks.
• Follow-up to assess healing and prevent stenosis.
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