Priority 25 from the Pessary use for Prolapse PSP

UNCERTAINTY: Does the use of a pessary during or after pregnancy prevent prolapse? (JLA PSP Priority 25)
Overall ranking	25
JLA question ID	0054/25
Explanatory note	Vaginal delivery is the single biggest factor in the development of prolapse. It is not yet fully understood what changes at the time of pregnancy and vaginal delivery cause the prolapse which most often presents later in life. Research which followed women who had used a pessary to help with perinatal vaginal heaviness might help us to better understand the factors contributing to prolapse development. Example: Is there a benefit in the early post natal period on fascia & organ position than can decrease the likelihood of prolapse further on?
Evidence	A trial is underway: https://w3.abdn.ac.uk/hsru/TOPSY/Public/Public/index.cshtml. The TOPSY trial is a multi-centre randomised control trial, with nested process evaluation, to test the clinical and cost-effectiveness of self-management of vaginal pessaries to treat pelvic organ prolapse, compared to standard care to improve women’s quality of life.
Health Research Classification System category	Renal and urogenital

Extra information provided by this PSP
Original uncertainty examples	Does using a pessary in the postpartum period minimise the risk of pelvic organ prolapse. ~ Does the use of a pessary during pregnancy prevent pop? ~ I think we (as physios) should be using more Pessaries. Even in the post-natal women to get them to return to exercise sooner while the pelvic floor is "catching up" ~ If there is a benefit in the early post natal period on fascia & organ position than can decrease the likelihood of prolapse further on?
Submitted by	4 x healthcare professionals

Extra information provided by this PSP

Original uncertainty examples

Does using a pessary in the postpartum period minimise the risk of pelvic organ prolapse. ~ Does the use of a pessary during pregnancy prevent pop? ~ I think we (as physios) should be using more Pessaries. Even in the post-natal women to get them to return to exercise sooner while the pelvic floor is "catching up" ~ If there is a benefit in the early post natal period on fascia & organ position than can decrease the likelihood of prolapse further on?

Submitted by

4 x healthcare professionals

PSP information
PSP unique ID	0054
PSP name	Pessary use for Prolapse
Total number of uncertainties identified by this PSP.	66 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	8 September 2017