The condition of the female genital organs changes during pregnancy. If you expectant mother The doctor revealed a shortening of the cervix; the course of pregnancy may be complicated. This article will tell expectant mothers more about this common pathology.

What is it?

The main reproductive organ in which the baby develops is the uterus. It is located in the lower half of the abdomen. During pregnancy, the size of the uterus changes significantly. This is necessary so that the baby during childbirth passed unhindered through the birth canal.

The cervix is ​​a kind of entrance to the uterine cavity. U different women its sizes are different. Average length This organ is usually 3.5 cm. For most women, this size is from 3 to 5 cm.

Changes in cervical length are a very important clinical indicator. Doctors note that this organ can be shortened to 2 cm or less. It is this pathology that is called shortening.

The cervix changes significantly during pregnancy. During this period in female body Uterine and then placental blood flow increases significantly. This process contributes to the strong proliferation of the cervical epithelium. This situation, as it develops, leads to the fact that the length of the cervix decreases significantly.

The proliferation of epithelial cells occurs during pregnancy under the influence of various specific hormones. Estrogens promote too strong hypertrophy of the muscular layer of the uterus, which leads to changes in the tone and condition of the cervix and cervical canal.

This situation in many women can even lead to the development of many pathologies, which may lead to the need for surgical gynecological treatment.

Reasons for shortening

Narrow and short neck uterus - this is common congenital pathology. Also, this pathological condition in the expectant mother can appear as a result of exposure to various traumatic actions. The cervix is ​​shortened after abortions, as well as during other surgical interventions.

Heredity - important sign, which may contribute to the development of such a disorder. In this case, similar changes occur in the mother, grandmother or sister of a pregnant woman.

In such a situation, quite often they even develop similar pathologies that appeared during pregnancy. Quite often adverse symptoms develop at 25-30 weeks of pregnancy.

Significant shortening of the cervix can also lead to physical activity. It is for this reason that doctors forbid the expectant mother to engage in active sports or put a lot of stress on your body. The optimal physical activity is regular walks. fresh air.

Another possible reason for the development this state are the consequences of various infectious diseases. Pregnancy is a period in a woman’s life accompanied by a decrease in immunity. This condition contributes to the fact that any pathogenic microbes can easily get to the cervix and cause inflammation there.

In order to reduce the likelihood of developing this condition even before pregnancy, a woman should definitely visit her doctor regularly.

The appearance of various scars on the cervix can also contribute to the shortening of this organ. These formations appear after any surgical interventions on the cervix, which are performed by obstetricians-gynecologists.

Pathologies that led to the treatment of this organ using a laser or alternative techniques can also contribute to the formation of various scars on this organ.

If the expectant mother is carrying a large baby or twins, then the risk of developing shortening also increases significantly. In this case adverse symptoms progress as pregnancy progresses.

This situation is due to the fact that the baby, developing in the mother’s womb, puts strong pressure on the cervix. Compression of this organ leads to the fact that it shortens significantly and becomes narrower.

Pathological conditions of the placenta can also lead to the development of this pathology. One of these pathological conditions is its presentation. Large sizes placentas putting pressure on the cervix cause compression, which contributes to the development of shortening of this organ.

Experts identify several of the most dangerous periods during pregnancy. This includes the time from 20 to 30 weeks of pregnancy. The most dangerous period for the development of this condition is the 16th week.

Symptoms

During the entire period of pregnancy, a woman should closely monitor her health. She may develop unfavorable signs at any time.

If the expectant mother begins to feel that her health is deteriorating, it is better for her to contact her obstetrician-gynecologist unscheduled.

Quite often, unfavorable symptoms appear in women at 21 weeks of pregnancy. This period of bearing a child is very important. At this time, the woman usually begins to feel the active movements of her baby

Reviews from many mothers indicate that they feel “jolts” or “kicks” in their tummy. This condition causes them to sea positive emotions and very inspiring.

If, against the background of such symptoms, a pregnant woman begins to notice that she has some kind of pain in the lower abdomen or bloody discharge from the vagina, then she should Be sure to quickly contact your doctor.

31-32 weeks of pregnancy - another one dangerous period pregnancy, when a woman's condition may worsen. Expectant mothers who are carrying twins or triplets should watch themselves most closely at this time.

Women suffering from polyhydramnios are also at increased risk for the development of this pathology. To prevent unfavorable symptoms from progressing during this period, doctors recommend to the expectant mother Get plenty of rest and limit physical activity.

Any psycho-emotional stress. A correct and rational daily routine is a very important task.

Danger to the expectant mother and fetus

Shortening of the cervix can lead to a significant threat to the course of labor. This condition threatens the development of isthmic-cervical insufficiency. This pathology may lead to premature birth.

Strong physical activity in this case can contribute to the deterioration of the general condition of the mother and her baby. Without medical intervention There is no way around this situation.

If the mucous membranes of this organ begin to soften greatly against the background of shortening, the lumen of the cervix expands. This contributes to the fact that the risk of infection of the baby increases many times over. This situation also contributes to the penetration of pathogenic microbes into the uterine cavity and into the cervical canal.

Too much short uterus, according to statistics, leads to an increase in premature births. Doctors note that women suffering from this pathology may require emergency obstetric care at 34-37 weeks of pregnancy.

A narrow and short uterus, especially in petite women, means that they may experience various injuries and ruptures during childbirth. In this case, stitches may be required. This condition requires longer rehabilitation and can significantly aggravate the first weeks of life after the long-awaited birth.

The risk of developing this pathology increases significantly in women who are carrying an overly large baby or several children at the same time.

Cervical ruptures

Quite often, a short cervix leads to the development of hypertonicity. This pathology also increases the risk of premature birth. This condition is manifested by the appearance of pain in the abdomen, bloody discharge from the vagina, dizziness and extreme fatigue. Only an obstetrician-gynecologist can identify this pathology during an extensive gynecological examination.

If hypertonicity against the background of a short cervix is ​​detected already at later pregnancy, then V dangerous situation may even require hospitalization. In this case, the expectant mother will undergo intensive treatment in a hospital setting. In this situation, “conservation” will also be offered to women with multiple pregnancies.

What to do?

It is important to note that if a woman has a short cervix before pregnancy, she should regularly visit her gynecologist. This is necessary in order to monitor the condition of this organ. Quite often, shortening of the uterus leads to the development of many dangerous pathologies.

However, in most cases, this pathological condition is determined only during pregnancy. It is identified by a gynecologist during an examination of the expectant mother on a chair. If violations are detected, the doctor must refer the woman on additional conduct transvaginal ultrasound examination.

Maintaining a daily routine

Doctors recommend that expectant mothers strictly monitor what they do during the day. The daily routine plays a big role important. In order to normalize the tone of the uterus, you should definitely get enough sleep regularly. Sleep should be at least 8-9 hours a day.

To prevent the cervix from further shrinking, The expectant mother should monitor her excessive emotions. Severe anxiety or worry over trifles leads to disruption in work nervous activity and spastic contraction of smooth muscles. This condition can only increase the shortening of the cervix.

Optimal physical activity helps the expectant mother maintain the tone of the female genital muscles. To normalize it, yoga classes for pregnant women or regular walks in the fresh air are suitable. Also, to prevent the worsening of this pathology, doctors prohibit the expectant mother from lifting weights.

Normalization overweight body is very an important condition maintaining the health of female genital organs. During pregnancy, the expectant mother already gains weight. This is due to the baby growing in her tummy, as well as the entire mass of all the placental membranes. Too much weight can lead to compression of the reproductive organs, which also causes shortening of the cervix.

In some cases, doctors may recommend that women suffering from this pathology wear special bandage. It helps to fix certain parts of the spine, and also somewhat reduces the likelihood of premature birth.

Shortening of the cervix is ​​not a contraindication for sexual intercourse. Only under certain acute pathologies Doctors may recommend that women limit their sexual activity. As a rule, such recommendations are given to expectant mothers latest dates their pregnancy.

Gynecological treatment

If, against the background of a short cervix, a woman has developed isthmic-cervical insufficiency, then she will require special treatment methods. In this case, doctors usually apply sutures that fix the os of the uterus. They will be removed only immediately before childbirth.

Some of the methods are surgical and are performed in an operating room. As a rule, in this case, mandatory intervention of an anesthesiologist is required.

Cervical cerclage is an invasive procedure that is performed to correct disorders that have arisen on the cervix. In this case, temporary sutures are placed on the cervix. They are necessary to ensure that it remains “closed” until the birth itself. Usually in this situation, sutures are applied before 26-27 weeks of pregnancy, since in the future this measure will be ineffective.

Another method of treating isthmic-cervical insufficiency caused by a too short cervix is ​​the application of an obstetric pessary. This special device is inserted into the cervical canal and fixes the pharynx from the inside. Installs obstetric pessary obstetrician-gynecologist.

This procedure is invasive, so requires mandatory training. It is better that it is performed only by an experienced and qualified doctor. After installing an obstetric pessary, doctors limit physical activity and recommend that expectant mothers get plenty of rest.

Drug therapy

In some situations, doctors may recommend that the expectant mother hormonal treatment. This is possible in cases where pathological changes the woman arose against the background of existing dishormonal disorders. In such a situation, doctors prescribe medications that compensate for the lack of specific female hormones.

"Utrozhestan"- this is one of the medicines prescribed to correct any violations that have arisen. This drug gynecologists can prescribe at the most different periods pregnancy. For up to 12 weeks, taking Utrozhestan promotes the attachment of the fetus to the wall of the uterus, as well as the beginning of its intrauterine development.

Taking this drug also significantly reduces the risk of spontaneous miscarriage. By the later weeks of pregnancy, the increase in progesterone in the blood decreases slightly. This physiological reaction is necessary to expel the fetus from the mother's womb. In this case, taking Utrozhestan may lead to a worsening of the final stage of pregnancy.

This drug can be prescribed in the form of capsules or various suppositories. In most cases, it is taken three times a day. Dosages are selected individually, taking into account the patient’s weight, whether she has concomitant diseases, as well as the nature of the pregnancy.

Expectant mothers should remember that any hormonal drugs must be prescribed by a doctor. Self-use of such drugs can lead to the development of quite dangerous conditions for the fetus and her own health.

A short cervix is ​​not at all a contraindication for planning pregnancy. With such physiological feature a woman can become a mother more than once. For the normal course of pregnancy, only timely monitoring of the baby’s condition while he is in the mother’s tummy is required.

It is better to determine the shortening of the cervix before conceiving the baby. The only exception is if this pathology occurs in a pregnant woman directly during pregnancy. Timely diagnosis this condition reduces the significant risk of developing various diseases both the pregnant woman and her baby

Gynecologist Lyudmila Shupenyuk will talk about how long the cervix should be during pregnancy in the next video.

Every woman dreams of a successful pregnancy and childbirth. healthy child. But pregnancy often occurs with complications, the threat of miscarriage, and can result in premature birth. There are many reasons for this. One of them is a short cervix during pregnancy (SCP). The main task of the doctor in this case is to do everything possible to prolong the pregnancy. And to help him with this, a woman must regularly visit a gynecologist and undergo all recommended examinations.

Normal anatomy of the body and cervix

The uterus is the organ in which a woman’s embryo forms and the fetus develops. It consists of several parts: the cervix, the isthmus and the body of the uterus, where the baby is located throughout pregnancy.

The cervix is ​​a cylinder or cone, the normal length of which is 3 or 4.5 cm. Its lower part, the vaginal part, is clearly visible when gynecological examination. The upper - supravaginal part is located above the vaginal fornix, it can only be examined with an ultrasound examination.

A narrow cervical canal runs inside the cervix. Closer to the isthmus, it ends with an internal pharynx. The main part of the muscles that form the sphincter (muscle ring) that holds the fetus in the uterus throughout pregnancy is concentrated here. The transition of the cervical canal into the vagina is called the external os.

During childbirth, the cervical canal performs the function birth canal. The rest of the time, thanks to the activity of the glandular epithelium endometrial mucosa, covering the cervical canal from the inside, it is filled with a mucous plug that protects the uterine cavity, and during pregnancy, the fetus, from the penetration of vaginal microflora.

What changes does the cervix undergo during pregnancy?

Normally non-pregnant woman The length of the cervix is ​​30-45 mm, its throat is closed. During pregnancy, the length of the cervix and the opening of the throat undergo changes. These indicators play important role in normal gestation. Therefore, women who have been diagnosed with a short cervix before or during pregnancy are at risk for miscarriage.

During pregnancy, uterine blood flow increases. The epithelium of the cervical canal grows and produces thick mucus. Its function is to prevent penetration pathogenic microorganisms into the uterine cavity. Under the influence of changing levels of estrogen during pregnancy, the muscular layer of the uterus hypertrophies, and the volume and length of the cervix also increase.

The doctor monitors the length of the cervix throughout the entire period of bearing a child. In order to prevent premature birth and miscarriages, during each ultrasound examination it is mandatory to measure it, since this indicator affects the success of pregnancy.

In the early stages, the cervix is ​​inelastic and quite dense. From 12 to 37 weeks, its length varies between 35-45 mm. By 38 weeks it begins to shorten and before birth it ranges from 10 to 15 mm. If long before this the cervix has shortened to 30 mm or more, then the pregnant woman needs constant monitoring and special observation.

Why is a short cervix dangerous for pregnant women?

A short cervix during pregnancy can cause isthmic-cervical insufficiency (ICI). This is a special condition in which the internal os of the cervix fails to cope with its obturator function, that is, the uterus physiologically cannot hold the fetus in its cavity, which also continues to increase in size and gain weight. Under increasing pressure, the cervix continues to open and shorten. This is why miscarriage occurs or premature birth.

A deformed cervix not only cannot hold the baby in its cavity, but is also unable to protect it from infections. With ICI, favorable conditions are created for ascending infection. Another danger of this condition is the rapid progress of labor, and as a consequence, the likelihood of ruptures of the vagina and perineum.

Causes of shortening and early dilatation of the cervix in women

Signs of early dilatation or a short cervix are detected most often at 15-20 weeks of pregnancy. It is during this period that the fetus begins to quickly gain weight and the load on the isthmus and cervix increases. Possible reasons there is a lot for this:

• hereditary structural features of the internal genital organs;
• congenital underdevelopment of the cervical canal, malformations of the uterus and genital infantilism;
• damage reproductive organs during intrauterine development;
• injuries received during pathological childbirth with cervical ruptures, abortions, surgical interventions, curettage of the uterine cavity, accompanied by mechanical expansion of the cervical canal;
• hormonal disorders in a woman’s body (excess of androgens - male sex hormones);
• dysplasia connective tissue, namely, pathologically increased content it contains relaxin.

A short cervix during pregnancy in itself is dangerous condition. It is aggravated by polyhydramnios, multiple pregnancies, and large fetuses.

Symptoms and diagnosis of a short neck

Diagnosis is based on instrumental, laboratory and clinical anamnestic data. A gynecologist can detect pathology during a vaginal examination of the patient. Accurate diagnosis carried out using ultrasound examination, or more precisely, cervicometry. IN secretory phase menstrual cycle An examination is carried out using a Hegar dilator No. 6. If it passes freely into the cervical canal, then ICN is diagnosed. On days 18-20 of the menstrual cycle, an X-ray examination is performed. With ICN, it will show the width of the isthmus (isthmus) of about 6 mm, with the norm being 2.6 mm.

A woman may suspect that she has a short cervix due to bloody or profuse watery discharge during pregnancy and pain in the lower abdomen.

Such symptoms may indicate a high risk of miscarriage, but they do not always appear. Therefore, you should not neglect the usual scheduled inspections and surveys that are carried out with for preventive purposes. Timely treatment of a short cervix will help maintain pregnancy and give birth healthy baby on time.

How ICN can affect the course of labor

If, with isthmic-cervical insufficiency, it was possible to carry the fetus to term and labor began on time, this does not mean that complications were avoided. CSM affects the course of labor. Childbirth occurs quickly or quickly. In primiparous women, rapid labor occurs in 4 hours or less, rapid labor in 6. In multiparous women, these numbers are lower - 2 and 4, respectively.

Such a rapid delivery is fraught with various complications, ruptures and injuries. Therefore, a short cervix in pregnant women is considered a pathology and requires treatment.

Treatment methods for ICI with a short cervix

If a woman is not pregnant, but is diagnosed with a short cervix, then the treatment is etiological, that is, it is aimed at eliminating the cause of the development of the pathology. Severe anatomical deformities of the cervix require surgical intervention - cervical plastic surgery. Before the operation, a thorough examination of the microflora is carried out and antibacterial treatment, since most often the uterine cavity is infected due to impaired obturator function of the cervical and isthmic part of the cervix.

After such an operation, in case of pregnancy, delivery using the method is recommended caesarean section. When there is no need for surgery, then bacteriological examination and treatment with antibiotics, taking into account the pathogen determined by the analysis. Further treatment is to control immune system and hormonal levels.

In pregnant women with ICI, treatment can be surgical, conservative and prophylactic. This depends on the timing of pregnancy, the length of the cervix and the threat of miscarriage. For women with their first pregnancy and for multipregnant women up to 20 weeks, the critical parameter for cervical length is 3 cm. Such patients are included in the risk group and require intensive monitoring.

In a multiple pregnancy up to 28 weeks, the lower norm for primiparous women is 37 mm, and for multiparous women - 4.5 cm. For those who have already given birth at 14 weeks, the normal cervical length is 3.6 cm. But if by the 20th week this figure decreases to 2.9 cm, then this already indicates an ICN. With a length of 2 cm or less, mandatory surgical correction.

The doctor can change treatment tactics based on additional parameters such as uterine tone and placenta location.

Surgical methods for treating ICI

Operations for a short neck are carried out using various methods:

1. mechanical narrowing of the internal os of the uterus (most preferred);
2. suturing the external pharynx;
3. narrowing of the cervix by strengthening the muscles along the side walls of the cervix.

Indications for surgical intervention are a history of miscarriages and premature births or progressive cervical insufficiency (its gradual shortening and softening).

Contraindications may include:

• heart, kidney, liver diseases;
• mental and genetic diseases;
• uncorrectable increased excitability of the uterine walls;
• bleeding during pregnancy;
• various developmental defects of the unborn child.

It is more advisable to perform the operation between 13 and 27 weeks of pregnancy. To prevent the infection from rising, surgery can be performed within a period of 7-13 weeks. If surgery is contraindicated for any reason, then conservative therapy is recommended, bed rest and medications reduce the excitability of the uterus.

Non-surgical correction methods

Correction methods for shortened cervical length and ICN have some advantages over surgical treatment methods. Firstly, they are simple and easy to apply even in an outpatient setting. Secondly, they are bloodless.

Pessaries and the Golgi ring are effective as prophylaxis for mild symptoms of pathology. But they are also used after surgical operations to relieve pressure on the sutured cervix.

Prevention of a short cervix

More effective is early prevention of this cervical pathology, which threatens the course of pregnancy. To this end, a woman must:

• use a reliable method of contraception to avoid abortion;
• be regularly examined by a gynecologist at least 1-2 times a year;
• plan pregnancy.

If the pathology was discovered for the first time or developed after pregnancy, then you need to ensure that the uterus is not in good shape, wear a bandage, and reduce physical activity.

You should not consider treatment for a shortened neck to be safe and ignore your doctor’s recommendations. Many women timely treatment This pathology helped eliminate the threat of miscarriage and premature birth and give birth to a healthy full-term baby.

Every woman dreams of a smooth pregnancy, without complications, and especially without the threat of miscarriage and premature birth. There are certain risks that lead to undesirable consequences– miscarriages and rapid premature births. One of these threats is a short cervix.

What is it

The cervix is ​​the rounded part of the uterus that connects it to the vagina. IN healthy condition its length varies from 3 to 4 cm, this is approximately a third of the entire length of the uterus. Under the influence negative factors this indicator can decrease to two or less centimeters, as a result of which the pregnant woman develops isthmic-cervical insufficiency.

The pathological condition is reflected in the performance of certain functions by the cervix - under the pressure of the increasing size of the fetus, the organ continues to shorten, opens prematurely and provokes miscarriage or premature birth. With this pathological condition cervix, infection of the fetus is possible, since the protective function is significantly weakened. During childbirth, there is a high risk of perineal and vaginal ruptures.

Reasons

• a short cervix may be a consequence anatomical feature structure of the female body;
• -consequence hormonal changes in the body caused by pregnancy. The pathology is especially pronounced in the second trimester;
• deformation of the cervix caused by previous abortions, surgery or multiple births;
• shortage;
• stressful situations, fears, worries;
• diseases of the uterus and cervix, infectious and inflammatory in nature, as a result of which the tissues of the organ are deformed and scarring occurs;
• deformation caused by uterine bleeding.

Examination and diagnosis of isthmic-cervical insufficiency
Isthmic-cervical insufficiency can be diagnosed with maximum accuracy in the second half of pregnancy, namely in the period from 14 to 24 weeks.

1. Examination by a gynecologist. At the appointment, the specialist assesses the condition of the cervix, the presence of discharge and its nature, as well as the size of the external pharynx. In a healthy state, the cervix should be tight, have a deviation in the backward direction, the external pharynx should be tightly closed and not allow a finger to pass through.
2. Ultrasound examination using a special sensor. In the first trimester, diagnosis is carried out with a transvaginal probe; in the future, transabdominal examination is used. Based on the diagnostic results, the specialist decides on further treatment methods that will allow you to maintain the pregnancy.

Normal cervical length by week

Ultrasound also determines the degree of maturity of the cervix, in conclusion this indicator is assessed in points.

Table of criteria by which cervical maturity is assessed

Each criterion is assessed by a corresponding number of points, which are summed up. The results look like this:

• from 0 to 3 – immature cervix;
• from 4 to 6 – not fully mature cervix, developing isthmic-cervical insufficiency;
• from 7 to 10 – fully matured cervix.

In a healthy state, until the 37th week, the cervix should be in an immature state, and transition to a mature state only before the onset of labor. It is important to consider that the inability of the cervix to transform into a mature state is also regarded as a pathology that requires specialist supervision and correction of the pregnant woman’s condition. It is likely that the woman will be offered delivery by caesarean section.

If ultrasound indicates borderline examination results and symptoms of premature birth are recorded, the pregnant woman is prescribed a repeat examination - ultrasound diagnostics to confirm the diagnosis and make appropriate adjustments.

1. If the cervix is ​​less than 1 cm in length, labor may begin at 32 weeks.
2. With a cervical length of 1 to 1.5 cm, birth occurs at 33 weeks.
3. With a cervical length of 1.5 to 2 cm, the duration of pregnancy is reduced to 34 weeks.
4. If the cervix is ​​between 2 and 2.5 cm long, labor begins at 36 weeks.

What to do with ICN
First of all, it is necessary to evaluate the results of the examinations and determine a further scheme of preventive and therapeutic measures. A short cervix is ​​one of the pathologies that, if properly careful attention and conducting preventive measures acceptance can be avoided. To do this you need:

• visit a gynecologist in a timely manner, because only during an examination can the first signs of pathology be identified and treatment prescribed;
• if the moment for conception is unfavorable, you need to use reliable methods of contraception;
• It is important to plan your pregnancy; this primarily applies to women who have had miscarriages.

Treatment

In many ways, success and the absence of problems during pregnancy with a short cervix depend on the efforts and attention of the woman herself. It is important not to miss visits to the gynecologist, to rest more to eliminate the possibility. It is necessary to wear a bandage and avoid physical activity. These simple preventive measures significantly reduce the risk of premature birth.

If changes in the structure of the cervix are minor, it is prescribed conservative therapy. To do this, a course of drugs is prescribed that normalizes physiological state uterus, relieve symptoms of tone. Treatment can be carried out with tablets or in the form of droppers.

If the cause of the pathology is a violation hormonal levels– overabundance male hormones– medications are prescribed that normalize the woman’s condition.

If after a course of therapy no improvements are recorded or the pathological condition is caused by a mechanical effect on the cervix, surgical correction or cervical cerclage is prescribed. The procedure is carried out under intravenous or epidural anesthesia; special fixing sutures are placed on the cervix to hold the fetus. The correction is carried out between 17 and 21 weeks. After the procedure, the patient spends 2-3 weeks on inpatient treatment under the supervision of a doctor and undergoing therapy antispasmodic drugs to avoid increasing the tone of the uterus. If pathogenic microflora or symptoms of infection are detected, a course is prescribed antibacterial drugs which are allowed during pregnancy. After discharge, the patient is required to visit a gynecologist every two weeks to monitor the condition of the cervix. Every month they take from a pregnant woman bacteriological culture and a smear to identify pathogenic microflora. At 37 weeks, the woman is hospitalized to prepare for childbirth and the stitches are removed so that they do not damage the cervix during childbirth.

Note: if the amniotic fluid has broken and labor begins, the sutures must be removed immediately, regardless of the stage of pregnancy.

If the diagnosis of “short cervix” is aggravated by concomitant infection or for other reasons surgery prohibited, non-surgical cerclage is performed. A special device is placed on the cervix pessary- obstetric pessary. The procedure can be carried out at least 5 weeks into pregnancy. The pessary functions as a kind of bandage that will help reduce pressure on the weakened cervix, protect the fetus from infection, and also preserve cerumen.

An obstetric pessary requires regular treatment, it is carried out every two to three weeks. At 37-38 weeks, the medical structure is removed.

Childbirth with ICN

A short cervix imposes certain features on the course of labor activity. Isthmic-cervical insufficiency causes the following processes:

• on initial stage During labor, a pregnant woman experiences cervical dilatation of 3-4 cm, usually such dilatation is recorded already in active phase childbirth;
• when active, regular contractions begin, the cervix dilates much more actively than in a healthy state - by 1 cm in 1.5-2 hours;

As a result, labor progresses and ends much faster; doctors distinguish two types of childbirth:

• fast - for first-time mothers less than six hours, for multiparous women about four hours;
• rapid - for primiparous women, labor ends in less than four hours, and for multiparous women in 2 hours.

Note: thus, a short cervix is ​​assessed by gynecologists as a serious, pathological condition that requires immediate correction and elimination. Doctors today give preference to a less invasive method of therapy - the introduction of an obstetric pessary.

Sex with a short cervix

Intimate relationships during pregnancy, like ultrasound using sensors, cannot cause miscarriage or premature labor. However, when diagnosing isthmic-cervical insufficiency, it is better for spouses to refrain from intimacy or exercise extreme caution so as not to complicate the course of the pathological process.

It is impossible to deprive a pregnant woman of intimacy, since as the size of the uterus increases, the outflow of blood from the genital organs slows down, and this causes an increase in libido. It is possible to normalize blood flow in the pelvic area, uterus, and also to activate the blood supply to the fetus only with the help of intimate release of the expectant mother. Sexual intercourse interrupted before reaching orgasm has a negative impact on emotional state women, leads to sleep disturbances, irritability and stagnation venous blood in the area of ​​the pelvic organs.

• sexual intercourse should be calm;
• the penetration should not be deep, this will eliminate the likelihood of injury to the cervix;
• the sexual partner should not have any infections, otherwise a condom should be used;
• during intimacy, it is necessary to exclude pressure on the mother’s abdominal area; the main criterion for choosing a position is that the woman should be comfortable;
• contractions of the muscular layer of the uterus during orgasm cannot provoke an increase in the tone of the uterus;
• semen contains substances that help soften the cervix, for this reason ejaculation into the vagina is prohibited before the 35th week of pregnancy;
• during anal sex you need to use a condom or lubricant; it is not advisable to use the same means of protection to continue sexual intercourse and penetration into the vagina, this can cause infection of the fetus, infection of the amniotic membranes and their rupture before the due date.

Note: During pregnancy, women often face problems such as swelling. hemorrhoids, in this case there is a high risk of injury and infection. To avoid unpleasant discomfort, you must avoid anal sex.

During pregnancy, you should not rely on your own feelings, especially when diagnosing a short cervix and isthmic-cervical insufficiency. It is important to inform your gynecologist about any unknown changes in your health status. A timely examination, examination, and prescribed therapy will help avoid many complications and unpleasant consequences during childbirth.

Every pregnant woman worries about her baby. When pregnancy proceeds without pathology, this pleases not only the woman, but also her attending physician.

One of the common pathologies of pregnancy is a short cervix. In order to understand what kind of diagnosis this is, what this condition entails and how to treat it, our article is devoted to it.

The lower segment of the uterus is represented by the cervix, or cervix, the center of which is the canal connecting the uterus to the vagina. Normally, the length of the cervix is ​​3 - 4 cm, while the cervical canal is closed and filled with mucus.

During a gynecological examination, the vaginal part of the cervix is ​​visible, which is assessed by a gynecologist.

The cervix is ​​connected to the uterus through 4 vaginal vaults:

• anterior fornix, which is located under the pubis;
• posterior fornix, located closer to the sacrum;
• 2 side vaults.

There are external and internal pharynx. Available for visual inspection:

• vaginal part of cervix;
• external os.

Shortening of the cervix occurs with increasing gestational age, and smoothing and opening of the cervical canal by 10 cm occurs during the birth process.

However, pregnancy does not always proceed according to the textbook. It happens that the cervix shortens ahead of schedule. This poses a risk of premature birth or late miscarriage.

Causes of shortening of the cervix

ICI, or isthmic-cervical insufficiency, is a pathological condition that is accompanied by a shortening of the length of the cervix compared to its original length, as well as its softening and opening of the pharynx. In this case, the external os is not closed during a vaginal examination, but is open from 0.5 cm or more, or the internal os is not closed during an ultrasound examination.

Among the reasons that can cause this pathological condition are:

1. Physiological characteristics of the pregnant woman's body.

In this case, the neck is initially short, and its length is less than 3.0 cm. This feature is not pathological if it does not shorten in the future.

1. Hormonal disorders.

In this case, a disruption occurs in the hormonal status of the pregnant woman. This pathology requires medical intervention.

1. History of traumatic lesion of the cervix.

This pathology is caused by surgical and other interventions on the cervix.

Among them, a special role is played by:

• forced instrumental expansion of the cervix during abortion;
• cauterization or conization;
• cervix ruptures during previous births;
• application of obstetric forceps or vacuum extractor;

1. The pathological course of this pregnancy, which is accompanied by increased stress on the cervix:
   • multiple pregnancy with two or more fetuses;
   • polyhydramnios;
   • large fruit;

1. Infectious lesions of a pregnant woman.

Require immediate treatment.

Close attention is paid to women who have a burdened obstetric and gynecological history:

• traumatic lesions of the cervix;
• spontaneous miscarriages in the later stages, after the 12th week of pregnancy.

This group of women is observed as a group at risk of miscarriage and is examined for a short cervix more often.

Symptoms and signs

Objective symptoms with a short cervix may be absent. Pathology is determined by vaginal examination or ultrasound.

In some cases, shortening of the cervix may be accompanied by symptoms of threatening spontaneous miscarriage or premature birth in the form of:

• pain in the lower abdomen of a pulling or aching nature;
• bloody or mucous-bloody discharge from the genital tract;
• discharge of the mucus plug.

Appearance danger signs threat is an indication for immediate hospitalization.

Diagnostics

Diagnosis of isthmic-cervical insufficiency is based on:

• vaginal examination;
• ultrasound examination.

During a vaginal examination, the doctor determines:

• length;
• consistency;
• condition of the external pharynx.

In a normal pregnancy, the cervix meets the following criteria: Length 3.0 - 4.0 cm, dense, external os closed.

An ultrasound examination can determine the length of the cervix and the condition of the internal os.

In order to monitor the condition of the cervix, a vaginal examination in the absence of pathology is carried out at the following times:

• when registering for pregnancy;
• 16 - 18 weeks;
• 30 weeks;
• 36 weeks.

If there are changes, the doctor performs vaginal examinations more often.

How dangerous is the disease?

The danger lies in the risk:

• development of late spontaneous miscarriage or premature birth. Due to the load that the cervix experiences, it may open early;
• infectious complications for the fetus, since there is no natural barrier in the form of mucus;
• fast or rapid labor, which is fraught with injuries to the cervix and vagina.

Prevention for short cervix

Prevention should begin before conception. Among the preventive measures are reliable contraception, which will help avoid abortions and cervical injuries.

In addition, an annual visit to the gynecologist can reveal possible problems cervix and carry out conservative treatment.

For a successful pregnancy, planning is necessary. An early visit to the gynecologist will help avoid many pitfalls when conceiving. Special attention Women with a burdened obstetric and gynecological history should show this.

Treatment depending on the week of pregnancy

Treatment depends on the timing of diagnosis. May be:

• suture;
• introduction of an obstetric unloading pessary.

Sutures can be placed until the 27th week of pregnancy. Suture application is effective even with a slight opening of the cervical canal.

The introduction of a pessary has more preventive value and helps relieve the fetal load on the cervix. There is a redistribution of the pressure force, but it turns out to be minimal and falls on the pessary.

In some cases, it is possible to combine methods. Particularly with multiple births.

The sutures and unloading pessary are removed at 38 weeks. If regular labor develops, premature rupture of amniotic fluid or bleeding occurs, they are removed immediately.

Depending on the pathology that led to the shortening of the cervix, medications are prescribed individually for each pregnant woman.

Sexual life with ICN

If a pregnant woman has a short cervix sex life not recommended. This is due to the fact that during sexual intercourse the risks of premature birth or spontaneous miscarriage increase.

Sexual activity is strictly prohibited with concomitant uterine tone, nagging pain in the lower abdomen, as well as when a suture is placed on the cervix or an obstetric unloading pessary is inserted.

Case from practice

Woman, 32 years old. Third pregnancy, real one. Childbirth in 2010, abortion in 2014. From the anamnesis: cauterization of the cervix due to erosion in 2011.

When registering: The cervix is ​​up to 2.5 cm long, dense, the external os is closed.

Routine examination at 16 weeks of pregnancy: the cervix is ​​the same.

At 19 weeks, complaints of periodic pain in the lower abdomen, the cervix was unchanged. Sent to hospital. After discharge, the cervix is ​​the same. When examined at 21 weeks of pregnancy: The cervix is ​​up to 1.5 cm long, softened, the external os is open to 1.0 cm. There are no complaints. He categorically refuses hospitalization. Yeast-like fungi in the smear. Outpatient therapy was prescribed.

Examination after 7 days: the cervix is ​​unchanged. An obstetric relief pessary was inserted on an outpatient basis. Therapy medications extended.

The woman is examined in a gynecological chair once every 14 days. He categorically refuses hospitalization.

At 38 weeks of pregnancy, the pessary is removed on an outpatient basis: The cervix is ​​up to 1.5 cm long, soft, the external os is open by 1.5 cm.

Childbirth through the birth canal at 39 - 40 weeks. A boy was born, 3670 g, 54 cm, 8/9 points on the Apgar scale.

Isthmic-cervical insufficiency cannot be equated with spontaneous miscarriage or premature birth. This pathological condition may be a factor in their development. However, with timely diagnosis and initiation of treatment, it is possible to successfully prolong pregnancy to full term.

Every woman dreams of an ideal pregnancy, which proceeds calmly, without complications associated with the threat of miscarriage and premature birth. But no one is immune from failure; sometimes things don’t end the way you want. If the cervix is ​​short during pregnancy, the risk of premature birth of the baby increases significantly.

Shortly before childbirth, the body begins to prepare for the upcoming event. The changes do not bypass the cervix - it becomes softer and shorter, so that at the crucial moment it is easier to open and release the baby from the birth canal. Sometimes this process, intended by nature, begins much earlier, and then the woman faces the threat of miscarriage or premature birth.

Normally, the length of the cervix is ​​3.5 cm, but if we're talking about about her pathological condition, then this figure drops to 2.5 cm or less. It is shaped like a cone. One third of its structure is represented by strong muscle fibers, which reliably fix the fetus in the reproductive organ during pregnancy.

If a woman’s shortened cervix is ​​due to heredity, then this fact can be recognized long before pregnancy. Girls who regularly visit a gynecologist from the onset of puberty are usually aware of their diagnosis. In order to avoid complications, it must be taken into account by the doctor at the stage of the patient’s planning for conception.

If a woman comes to the gynecologist while already pregnant, then the doctor will be able to establish the fact of a short cervix during a routine examination on the gynecological chair. As a rule, in these cases, the specialist additionally refers the patient to a transvaginal ultrasound examination, which can confirm his assumption.

Why is a short neck dangerous during pregnancy?

The greatest danger of a short cervix during pregnancy is (ICN), leading to the threat of miscarriage. If its length is less than 2.5 cm, then it will not be able to hold the fetus for a long time and premature opening of the uterus will begin. Pathology not detected in time leads to pregnancy loss.

During the birth itself, there is a high probability of its rapid progression and complications associated with this: injuries, ruptures, etc. In addition, a shortened cervix reproductive organ does not reliably protect the fetus from infection, since in this case there is no complete barrier against pathogenic microflora penetrating from the outside.

Fortunately, this condition is not an obstacle to motherhood. Even in the presence of isthmic-cervical insufficiency, it is possible to carry and give birth to a child if the necessary treatment and preventive measures are taken in time.

Reasons

A short cervix during pregnancy can negatively affect the entire process of bearing a child. This pathology is aggravated by such concomitant factors as a large fetus, polyhydramnios and multiple births.

Causes of shortening of the cervix:

• congenital pathologies caused by genetics: incomplete development of the cervical canal, abnormal structure of the uterus, sexual infantilism;
• hormonal abnormalities that arise during pregnancy;
• hyperandrogenism;
• acquired injuries to the cervix of the reproductive organ received during childbirth, abortion or curettage;
• organ dysplasia.

Symptoms

For the first time, symptoms of a shortened cervix make themselves felt from the 16th week of pregnancy. The fact is that from this moment the fetus begins to gain body weight faster, exerting more pressure to the uterine os. The doctor can discover this during the next examination in the gynecological chair. The expectant mother usually does not have any complaints.

IN in rare cases symptoms of a short cervix during pregnancy are manifested by minor discharge mixed with blood or copious mucous discharge from the genital tract, pain in the lower abdomen. If a woman has these signs, the doctor will definitely refer her to Ultrasound examination. The first symptom of a miscarriage or premature birth is bleeding at any stage.

Diagnostics

Diagnosis of the cervical condition is usually carried out before the 12th week of pregnancy, at the moment when the woman comes to antenatal clinic to register for pregnancy.

A comprehensive examination includes the following stages:

1. Digital examination of the vagina, during which the doctor assesses the length of the cervix, its patency and the condition of the cervical canal.
2. Examination in the mirrors, which allows you to clarify the condition of the external os of the cervix.
3. An ultrasound examination, which not only confirms the presence of pathology, but also allows you to monitor its development in the future.

The doctor will see that the cervix is ​​shortened after the first vaginal examination of the patient. But he can make a diagnosis only based on the results ultrasound examination performed transvaginally.

Treatment

If a woman has a history of spontaneous miscarriages and premature births, or during this pregnancy she is diagnosed with isthmic-cervical insufficiency, then she will have to be closely monitored by a doctor throughout the entire gestation period.

If a short cervix is ​​detected during pregnancy, what should you do? Unfortunately, it is impossible to increase the length of a shortened organ. Therefore, treatment should be aimed at maintaining pregnancy and preventing premature onset of labor.

Doctors use two tactics in treating such patients. WITH therapeutic and preventive purpose, if the cervix has shortened slightly during pregnancy, a pessary is installed on its sphincter, which reduces pressure amniotic sac, fixing the uterus in a certain projection and preventing the opening of the uterine pharynx ahead of schedule.

If the cervix is ​​seriously shortened or the external os is opened, it becomes necessary to apply sutures that will mechanically prevent the subsequent opening of the cervix until the time of birth. This procedure cannot be postponed: a short cervix can be sutured during a pregnancy of 30 weeks or less.

If the shortening of the organ is caused by hormonal imbalance, the condition is corrected by prescribing hormone therapy to the woman. Also, the doctor should give the patient a number of recommendations, such as wearing a prenatal bandage, limiting physical activity, sexual abstinence.

Prevention

Prevention of premature cervical dilatation during pregnancy should begin long before conception, even from the moment of sexual activity. It includes the following aspects:

• reliable contraception aimed at preventing unwanted pregnancy and subsequent abortions;
• regular observation by a gynecologist in order to timely identify health problems and eliminate them;
• adequate pregnancy planning, especially for women who have experienced abortions, miscarriages and premature onset of labor in the past;
• maintaining a healthy intimate life(absence of promiscuity, protected sexual intercourse, etc.).

A short cervix leads to serious problems during pregnancy. The health of the mother and child, namely the outcome of pregnancy, depends on its condition.