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About Mohamed Kandeel
Expertise
I can answer questions about antenatal care, medical problems associated with pregnancy, labor and delivery and postpartum care.

Experience
Currently I am working as a Professor of Obstetrics gynecology, Menofyia University, Egypt. Since 1987, I worked in many university and private hospitals with a high load of pregnant population averaging 7-9,000 deliveries/year. This exposed me to all problems associated with pregnancy, labor and delivery. I had my doctorate degree in Obstetrics and Gynecology in 1996 in the use of Doppler ultrasound in high risk pregnancies.

Organizations
Menofyia University, Egypt

Publications
-British Journal of Obstetrics and Gynecology (Kandil M) -Egyptian Journal of Obstetrics and Gynecology (Kandil M) -Ain Shams Journal of Medicine (Kandil M)

Education/Credentials
-Master's degree in obstetrics and Gynecology 1989 -Doctorate degree in Obstetrics and Gynecology 1996

Awards and Honors
Editorial advisor: Fetal monitoring section of the international website www.obgyn.net

You are here: Experts > Health/Fitness > Obstetrics/Gynecology > ObGyn/Pregnancy issues > Pelvic Organ Prolapse and Subsequent Pregnancy

ObGyn/Pregnancy issues - Pelvic Organ Prolapse and Subsequent Pregnancy

Expert: Mohamed Kandeel - 11/6/2009

Question
At age 27, after a normal pregnancy, I gave birth to my daughter (7 lbs) by vaginal delivery with a second degree tear between vagina and anus. The tear was surgically repaired immediately after the birth. Several weeks after the birth, I noticed a large bulge coming out of my vagina. I returned to the doctor and was told that I had a 2nd degree cystocele, a uterine prolapse between 1st and 2nd degree, and a 1st degree rectocele. I was prescribed a pessary. I wore the pessary every day. After 1 year, the prolapses improved a tiny bit, but not much. I am considering a second pregnancy but am confused by the conflicting information I have gotten from several doctors. I have heard that a second pregnancy will make it worse. I have heard that it will not make it worse. I have heard that it makes preterm labor more likely. I have heard that it is fine to deliver vaginally. I have heard that it is better to get a c-section. I have heard that pregnancy would be far more painful and may require bed rest. Why are there so many contradictory opinions? Please help!

Answer
Dear Kelly

Definitely, a second pregnancy and delivery will make your prolapse worse. No doubt. However it has no relation to preterm delivery. It may affect your ability to control urine and few drops may escape involuntarily on coughing, sneezing and similar ocassions in more severe degress.

Surgical repair of prolapse is advisable and it gives excellent results. Normal vaginal delivery can occur 2-3 after repair without sequelae and without a need for Cesarean section. At present a C.S. would not give you the benefit you think as you will still have the prolapse after delivery and a corrective surgery will remain a necessity. If you deliver vaginally, the prolapse would worsen and the corrective surgery will be needed meaning that this corrective surgery for prolapse is a must in all circumstances.

I hope that these info are helpful to you and I do wish you the best of luck.

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