Publication:

Advanced uterovaginal prolapse in the presence of dense ventral uterine fixation: highlighting the dominant role of pelvic floor support

Uterovaginal prolapse is commonly attributed to multiparity and pelvic floor weakness, while dense anterior uterine fixation is generally presumed to limit uterine descent. We report a rare case of advanced uterovaginal prolapse occurring despite dense ventral uterine fixation. A 30-year-old multiparous woman presented with complaints of something protruding per vaginum for 1 year. Clinical examination revealed third-degree uterovaginal prolapse with associated anterior and posterior compartment defects. She was planned for laparoscopic uterine–preserving surgery. Intraoperatively, the uterus, along with both round ligaments, was found to be densely adherent to the anterior abdominal wall, consistent with ventral uterine fixation. Extensive adhesiolysis was required to restore uterine mobility, following which uterosacral ligament plication was performed. Due to distorted anterior anatomy, anterior compartment repair was completed vaginally. Postoperative recovery was uneventful with satisfactory anatomical correction. This case highlights that anterior uterine fixation does not necessarily prevent uterovaginal prolapse and emphasizes the dominant role of pelvic floor and apical support in maintaining uterine position.