Pelvic organ prolapse during pregnancy

By trimester

Weeks 1–13

1st trimester

Newly appearing prolapse is uncommon this early, since the condition overall affects only about 1 in 10,000 to 15,000 pregnancies. If you already had some degree of prolapse before conceiving, this is when to mention it at a prenatal visit so a plan is in place before symptoms escalate.

Weeks 14–27

2nd trimester

Rising uterine weight and pelvic pressure can make a bulge or heaviness more noticeable now. If symptoms are bothersome, a Gellhorn or ring pessary is the typical next step, fitted once your provider confirms there is no active vaginal infection and that you can return for follow-up checks.

Weeks 28–birth

3rd trimester

A pessary in place is usually removed once labor begins and can be reinserted after delivery if you still need the support once bleeding has settled. Vaginal delivery is not ruled out by prolapse in most cases; a cesarean is reserved for severe, non-reducible prolapse that is obstructing labor.

What does the evidence show for pelvic organ prolapse?

• Pelvic organ prolapse identified during an ongoing pregnancy is uncommon, with a reported incidence of about one case for every 10,000 to 15,000 pregnancies, and surgery is avoided as first-line management because of surgical and anesthetic risk plus possible effects on the pregnancy itself. 1
• Pregnancy case literature describes use of different pessary types, including Gellhorn and ring devices. Selection depends on individual anatomy and clinical assessment, with infection assessment and reliable follow-up important to the plan. 1
• Reported complications of prolapse in pregnancy include heavy or foul-smelling vaginal discharge, urinary or vaginal infection, vaginal or cervical erosion, and difficulty voiding or having a bowel movement, with cervical ulceration and preterm delivery named as possible obstetric risks. 1
• Published pregnancy reports describe successful vaginal births as well as circumstances where severe swelling or unreduced prolapse can obstruct labor. These small reports do not establish one delivery approach for everyone; the obstetric team should individualize the birth plan. 1
• In a documented case, a ring pessary was fitted at 23 weeks 4 days for worsening prolapse, removed once labor began at 37 weeks 3 days, and reinserted after delivery once lochia had decreased; at the six-week follow-up the prolapse remained well controlled with no complications. 2
• Complications listed alongside pessary use for prolapse in pregnancy include cervical edema or ulceration, urinary symptoms, preterm labor, labor dystocia, and cervical laceration, which is why regular reassessment is part of the plan rather than a one-time fitting. 2
• Prolapse in general produces pressure or heaviness in the pelvis or vagina, sometimes with the cervix or uterus bulging into or past the vaginal opening, and a pessary is described as a rubber or plastic donut-shaped device placed in the vagina to hold pelvic organs in position. 3
• ACOG describes pessaries as supports available in different shapes and sizes, selected according to symptoms and the type of prolapse. Its general guidance helps explain the device; pregnancy-specific suitability, fitting, and follow-up still require the obstetric team. 4

When should I call my provider about pelvic organ prolapse?

Call your provider promptly for vaginal discharge that turns heavy, foul-smelling, or blood-tinged, for new difficulty emptying your bladder or bowels, or for a bulge that looks raw, ulcerated, or will not go back in, since these point toward erosion or infection rather than ordinary pressure. Regard any signs of preterm labor, such as regular tightening or pelvic pressure that comes in waves, as a same-day call, since preterm delivery is one of the obstetric risks named alongside prolapse in pregnancy. A pessary that becomes painful, will not stay in place, or is overdue for its follow-up check should not be left unaddressed, since untreated erosion or infection is what typically turns a manageable prolapse into a complicated one. None of these lists replace your own judgment: if this symptom worries you, that on its own is enough reason to check in with your healthcare provider.