give head low position,good antibiotics if any local infection.when labour pain starts if everything suitable for normal delivery then go ahead.sos needed LSCS.tried to keep the prolapse part inside.support with pad.

Dear Rajshree, thank you for your advice. Very useful . I was wondering how to manage them in order to prolong the pregnancy; ring pessary, vaginal pack, something different. Also to induce or not after 37 weeks? Thank you.

Suggestion; just to temporarily insert a pessary, which can be taken out at the time of delivery as to diminish bother from the prolapse. That is usually very well tolerated.

It is a rare occurrence as uterine prolapse usually appears in women past their reproductive age. There may be a general weakness of the connective tissue, most often running in the family. For a second (or third) degree of uterine prolapse, a ring pessary may be useful. Could not find any literature on its use or possible complications; common sense says that it may be safe to use if it brings relief of symptoms. In the second half of pregnancy, no pessary may be necessary, as the uterus ascends in the abdomen and the prolapse would be reduced.

Labor and delivery should be normal; some are of the opinion that the dilatation progresses faster, given the reduced resistance of the cervix. I would advise the patient against bearing down against an incompletely dilated cervix. Assisted delivery, if required, is probably less damaging when the head is already on the perineum and rotated.

A ring pessary may be useful again in post-partum and beyond, if the woman desires more children. Surgical correction has to be planned for over 6 months after delivery. It should preferably be done when there are no plans for future pregnancies. It is possible to preserve the uterus but a subsequent pregnancy would most probably compromise the uterine suspension.

The diagnosis and management is quite different. I have a study near completion, yet to be published of 35 mothers from India. I have pictorial description of each and every mothers. 

 Prolapse during pregnancy of two types one is preexisting and another first time seen during pregnancy [Evidence based]. Those preexisting cases to be reduced manually and kept in position by pessary[Specially ring pessary]. Regular washing and reinsertion is mandatory. After first half of pregnancy, they should be removed and observe whether prolapse is present or not. If it comes out, continue pessary till term. Assess the cervix, if it is cicatrised go for CS. Before that, reduction is must. If cervix is soft, you can go for vaginal delivery. In that case it is very easy to deliver them. If cervix is more outside vagina you can try it for Dhrrussen's technique[I did three cases]. 

 Following delivery, you can not see the prolapse after its reduction. Advice her to come after 6 weeks, reassess it.