Pelvic organ prolapse (POP) is defined by ICS as the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus, or the apex of the vagina (vaginal vault after hysterectomy) (1). POP causes significant discomfort and greatly affects the quality of life, activities of daily living, sexual activity and exercise and has a negative impact on a woman’s body image. According to existing studies, the reported prevalence of POP varies widely, ranging from 3 to 50%. In India, nulliparous prolapse constitutes 1.5 to 2% of prolapse. The incidence is even higher (5–8%) for young women who have delivered one or two children, thus making it one of the highest rates in the world (2). In women with nulliparous prolapse, there usually is a component of cervical elongation without associated anterior (cystocele) or posterior (rectocele) compartment prolapse.
There are a variety of surgical management options, both conservative and extirpative for repair of pelvic organ prolapse (POP). Surgical treatment for POP includes native tissue repair, augmentation with mesh, and minimally invasive surgeries by laparoscopy and robotics; each one with its own advantages and disadvantages.
Amongst the various hysteropexies described, one of the procedures is iliococcygeous muscle suspension which is technically easy to perform with less complications rate. But in women with infravaginal elongation of cervix and cervical hypertrophy, anatomical success cannot be achieved with hysteropexy alone sometimes. In such cases, Manchester Fothergill procedure can be combined with hysteropexy for excellent anatomical outcomes.

It was a retrospective study on three women who had grade III uterocervical descent with cervical elongation and hypertrophied cervix. All underwent Manchester Fothergill repair along with Ilicoccygeous muscle suspension at a tertiary care hospital. All the women were followed up at 6 months after surgery to see the anatomical success rate defined as POP Q stage 0 or 1 prolapse.

The mean age of the women undergoing this procedure was 28.33 years. All were parous, with mean parity of 2. The presenting complaint for all was mass descending through vagina. All of them had Stage III uterocervical descent with cervical elongation and hypertrophy of cervix. The mean infravaginal cervical length was 8.33 cm. The mean operative time was 43.33 minutes. No intraoperative or immediate postoperative complications were noted. Postoperatively, at 6 months, all patients were symptomatically relived of their presenting complaints. On examination, 2 women had POP-Q stage 0 prolapse while 1 woman had POP-Q stage 1 prolapse. Thus, surgery was successful in 100% of woman for treatment of prolapse.

Combining Manchester-Forthergill procedure along Iliococcygeous muscle suspension is an excellent procedure with 100% success rates at 6 months for women with uterocervical prolapse with a component of infravaginal cervical elongation and cervical hypertrophy.

Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecology J. 2016 Feb;27(2):165–94.
Virkud A. Conservative Operations in Genital Prolapse. J Obstet Gynaecol India. 2016 Jun;66(3):144–8.