Normal and timely labor never begins suddenly and violently. On the eve of childbirth, a woman experiences their precursors, and the uterus and its cervix are prepared for the birth process. In particular, the cervix begins to “ripen” and expand, that is, it enters the stage of opening of the uterine pharynx. Childbirth is a complex and lengthy process and largely depends on the interaction of the uterus, cervix and hormonal levels, which determines its successful completion.

The cervix is...

The lower part of the uterus is called its cervix, which looks like a narrow cylinder and connects the uterine cavity to the vagina. Directly in the cervix, the vaginal part is distinguished - the visible part, which protrudes into the vagina below its fornix. There is also a supravaginal part - the upper part located above the arches. The cervical canal passes through the cervix, its upper end is called the internal os, and the lower end is called the external os. During pregnancy, there is a mucus plug in the cervical canal, the function of which is to prevent infection from entering the uterine cavity from the vagina.

The uterus is a female reproductive organ, the main purpose of which is to bear a fetus (fetal receptacle). The uterus consists of 3 layers: the inner one is represented by the endometrium, the middle one is muscle tissue and the outer one is the serosa. The bulk of the uterus is the muscular layer, which hypertrophies and grows during gestation. The myometrium of the uterus has a contractile function, due to which contractions occur, the cervix (uterine os) opens and the fetus is expelled from the uterine cavity during labor.

Periods of labor

The labor process lasts quite a long time, and normally in primiparous women it lasts 10–12 hours, while in multiparous women it lasts approximately 6–8 hours. Childbirth itself includes three periods:

• I period – the period of contractions (opening of the uterine pharynx);
• The second period is called the period of pushing (the period of expulsion of the fetus);
• The third period is the period of separation and discharge of the child's place (placeholder), therefore it is called the afterbirth period.

The longest stage of labor is the period of opening of the uterine pharynx. It is caused by uterine contractions, during which the amniotic sac is formed, the fetal head moves along the pelvic ring and cervical dilatation is ensured.

Period of contractions

First, contractions arise and become established - no more than 2 in 10 minutes. Moreover, the duration of uterine contraction reaches 30–40 seconds, and uterine relaxation reaches 80–120 seconds. Long-term relaxation of the uterine muscles after each contraction ensures the transition of the cervical tissues into the structure of the lower segment of the uterus, as a result of which the length of the visible part of the cervix decreases (it shortens), and the lower uterine segment itself stretches and lengthens.

As a result of the ongoing processes, the presenting part of the fetus (usually the head) is fixed at the entrance to the pelvis, separating the amniotic fluid, and as a result, anterior and posterior waters are formed. A fetal bladder is formed (contains anterior waters), which acts like a hydraulic wedge, wedges into the internal os, opening it.

In first-time mothers, the latent phase of dilatation is always longer than in women giving birth for the second time, which determines the longer total duration of labor. The completion of the latent phase is marked by complete or almost complete effacement of the cervix.

The active phase begins with 4 cm of cervical dilation and continues up to 8 cm. At the same time, contractions become more frequent and their number reaches 3 - 5 in 10 minutes, periods of contraction and relaxation of the uterus are equalized and amount to 60 - 90 seconds. The active phase lasts for primiparous and multiparous women for 3–4 hours. It is during the active phase that labor becomes intense, and the cervix dilates quickly. The fetal head moves along the birth canal, the cervix has completely moved into the lower uterine segment (merged with it), and by the end of the active phase the opening of the uterine pharynx is complete or almost complete (within 8 - 10 cm).

At the end of the active phase, the amniotic sac is opened and the water is released. If the cervical opening has reached 8 - 10 cm and the waters have broken, this is called timely rupture of water, the release of water when the opening is up to 7 cm is called early, with 10 or more cm of opening of the pharynx, amniotomy is indicated (the procedure for opening the amniotic sac), which is called delayed rupture of water.

Terminology

Dilatation of the cervix does not have any symptoms; only a doctor can determine it by conducting a vaginal examination.

To understand how the process of softening, shortening and smoothing of the cervix progresses, you should define obstetric terms. In the recent past, obstetricians determined the opening of the uterine pharynx in the fingers. Roughly speaking, how many fingers the uterine os allows through, so is the opening. On average, the width of the “obstetric finger” is 2 cm, but, as you know, everyone’s fingers are different, so measuring the opening in cm is considered more accurate. So:

• if the cervix is ​​dilated by 1 finger, then they speak of an opening of 2 - 3 cm;
• if the opening of the uterine pharynx has reached 3–4 cm, this is equivalent to the dilation of the cervix by 2 fingers, which, as a rule, is diagnosed already at the beginning of regular labor (at least 3 contractions in 10 minutes);
• almost complete opening is indicated by the opening of the cervix by 8 cm or 4 fingers;
• full dilatation is recorded when the cervix is ​​completely smoothed (thin edges) and is passable for 5 fingers or 10 cm (the head descends to the pelvic floor, turning with an arrow-shaped suture to a straight size, an irresistible desire to push appears - it’s time to go to the delivery room for the birth of the baby - the beginning of the second period childbirth).

How does the cervix ripen?

The appearing harbingers of labor indicate the imminent onset of labor (approximately from 2 weeks to 2 hours):

• the fundus of the uterus descends (for 2 - 3 weeks before the onset of contractions), which is explained by the pressing of the presenting part of the fetus to the pelvis, a woman feels this sign by easier breathing;
• the pressed head of the fetus puts pressure on the pelvic organs (bladder, intestines), which leads to increased urination and constipation;
• increased excitability of the uterus (the uterus “turns to stone” when the fetus moves, the woman moves suddenly, or when the abdomen is stroked/pinched);
• possible appearance - they are irregular and sparse, drawn-out and short;
• The cervix begins to “ripen” - it softens, allows the tip of the finger to pass through, shortens and “centers.”

Dilatation of the cervix before childbirth occurs very slowly and gradually over the course of a month, and intensifies on the last day or two before birth. In primiparous women, the opening of the cervical canal is about 2 cm, while in multiparous women the opening exceeds 2 cm.

To establish cervical maturity, a scale developed by Bishop is used, which includes assessment of the following criteria:

• consistency (density) of the neck: if it is dense - this is regarded as 0 points, if it is softened along the periphery, but the internal pharynx is dense - 1 point, soft both inside and outside - 2 points;
• length of the neck (the process of its shortening) - if it exceeds 2 cm - 0 points, the length reaches 1 - 2 cm - score 1 point, the neck is shortened and does not reach 1 cm in length - 2 points;
• patency of the cervical canal: a closed external pharynx or the tip of a finger passes through - score 0 points, the cervical canal is passed to a closed internal pharynx - this is scored as 1 point, and if the canal allows one or 2 fingers to pass beyond the internal pharynx - scored at 2 points;
• how the neck is located tangentially to the wire axis of the pelvis: directed posteriorly - 0 points, displaced anteriorly - 1 point, located in the middle or “centered” - 2 points.

When summing up the points, the maturity of the cervix is ​​assessed. An immature cervix is ​​considered with a score of 0 - 2 points, 3 - 4 points are regarded as an insufficiently mature or ripening cervix, and with 5 - 8 points they speak of a mature cervix.

Vaginal examination

To determine the degree of readiness of the cervix and not only, the doctor conducts a mandatory vaginal examination (upon admission to the maternity hospital and at 38–39 weeks at an appointment at the antenatal clinic).

If the woman is already in the maternity ward, a vaginal examination to determine the process of opening of the uterine pharynx every 4 to 6 hours or for emergency indications:

• discharge of amniotic fluid;
• carrying out a possible amniotomy (weakness of labor, or flat amniotic sac);
• with the development of anomalies of labor forces (clinically narrow pelvis, excessive labor, incoordination);
• before performing regional anesthesia (EDA, SMA) to determine the cause of painful contractions;
• the occurrence of bloody discharge from the genital tract;
• in the case of established regular labor (preliminary period, turning into contractions).

When conducting a vaginal examination, the obstetrician assesses the condition of the cervix: its degree of dilation, smoothing, thickness and extensibility of the cervical edges, as well as the presence of scars on the soft tissues of the genital tract. In addition, the capacity of the pelvis is assessed, the presenting part of the fetus and its insertion are palpated (localization of the sagittal suture on the head and fontanelles), the advancement of the presenting part, the presence of bone deformities and exostoses. The amniotic sac must be assessed (integrity, functionality).

Based on subjective signs of dilatation and vaginal examination data, a partogram of labor is compiled and maintained. Contractions are considered subjective signs of labor, in particular the opening of the uterine pharynx. The criteria for assessing contractions include their duration and frequency, severity and uterine activity (the latter is determined instrumentally). The partogram of labor allows you to visually record the dynamics of the opening of the uterine pharynx. A graph is drawn up, the horizontal length of which indicates the duration of labor in hours, and the vertical dilatation of the cervix in cm. Based on the partogram, the latent and active phases of labor can be distinguished. A steep rise in the curve indicates the effectiveness of the birth act.

If the cervix dilates prematurely

Dilation of the cervix during pregnancy, that is, long before childbirth, is called isthmic-cervical insufficiency. This pathology is characterized by the fact that both the cervix and the isthmus do not perform their main function during gestation - obturator. In this case, the cervix softens, shortens and smoothes, which does not allow keeping the fetus in the sac and leads to spontaneous abortion. Termination of pregnancy usually occurs in the 2nd – 3rd trimesters. The incompetence of the cervix is ​​indicated by the fact that it shortens to 25 mm or less at 20–30 weeks of gestation.

Isthmic-cervical insufficiency can be organic and functional. The organic form of pathology develops as a result of various cervical injuries - induced abortions (see), cervical ruptures during childbirth, surgical methods for treating cervical diseases. The functional form of the disease is caused either by a hormonal imbalance or by an increased load on the cervix and isthmus during pregnancy (multiple pregnancy, excess water or a large fetus).

How to maintain pregnancy when the cervix is ​​dilated

But even with cervical dilatation by 1 - 2 fingers at a period of 28 weeks or more, it is quite possible to maintain the pregnancy, or at least prolong it until the birth of a completely viable fetus. In such cases, the following are prescribed:

• bed rest;
• emotional peace;
• sedatives;
• antispasmodics (magne-B6, no-spa,);
• tocolytics (ginipral, partusisten).

Treatment is mandatory aimed at producing surfactant in the fetal lungs (glucocorticoids are prescribed), which accelerates their maturation.

In addition, treatment and prevention of further premature cervical dilatation is carried out surgically - sutures are placed on the cervix, which are removed at 37 weeks.

The cervix is ​​immature - what then?

The opposite situation is possible, when the cervix is ​​“not ready” for childbirth. That is, hour X has arrived (the expected date of birth), and even several days or weeks have passed, but no structural changes are observed in the cervix, it remains long, dense, deviated posteriorly or anteriorly, and the internal pharynx is impassable or allows the tip of the finger to pass through. What do doctors do in this case?

All methods of influencing the cervix, leading to its maturation, are divided into medicinal and non-medicinal. Medicinal methods include the introduction of special gels and suppositories with prostaglandins into the vagina or cervix. Prostaglandins are hormones that accelerate the process of cervical ripening, increase the excitability of the uterus, and during childbirth their intravenous administration is practiced in case of weakness of labor forces. Local administration of prostaglandins has no systemic effect (no side effects) and contributes to the shortening and smoothing of the cervix.

Non-medicinal methods of stimulating cervical dilatation include:

Sticks – kelp

The sticks are made from dried kelp seaweed, which are highly hygroscopic (they absorb water well). Such a number of sticks are inserted into the cervical canal so that they fill it tightly. As the sticks absorb liquid, they swell and stretch the cervix, causing it to dilate.

Foley catheter

The catheter for dilating the cervix is ​​represented by a flexible tube with a balloon attached to one end. A catheter with a balloon at the end is inserted by the doctor into the cervical canal, the balloon is filled with air and left in the cervix for 24 hours. Mechanical action on the cervix stimulates its opening, as well as the production of prostaglandins. The method is very painful and increases the risk of infection of the birth canal.

Cleansing enema

Unfortunately, some maternity hospitals have refused to perform a cleansing enema for a woman admitted to give birth, but in vain. Free intestines, as well as its peristalsis during defecation, increase the excitability of the uterus, increase its tone, and, consequently, accelerate the process of cervical dilatation.

Question - answer

How can you speed up cervical dilatation at home?

• long walks in the fresh air increase the excitability of the uterus and the production of prostaglandins, and the presenting part of the baby is fixed at the entrance to the pelvis, further stimulating the opening of the cervix;
• take care of your bladder and intestines, avoid constipation and prolonged abstinence from urination;
• eat more salads made from fresh vegetables dressed with vegetable oil;
• take a decoction of raspberry leaves;
• stimulate the nipples (when they are irritated, oxytocin is released, which causes uterine contractions).
• Are there any special exercises for opening the cervix?

At home, cervical ripening is accelerated by walking up stairs, swimming and diving, bending and turning the body. It is also recommended to take a warm bath, massage the ear and little finger, breathing exercises and exercises to strengthen the perineal muscles, and do yoga. In maternity hospitals there are special gymnastic balls, the seat and bounces on which during labor accelerate the opening of the uterine pharynx.

Does sex really help prepare your cervix for childbirth?

Yes, having sex in the last days and weeks of pregnancy (provided the amniotic sac is intact and there is a mucus plug in the cervical canal) contributes to the ripening of the cervix. First, during orgasm, oxytocin is released, which stimulates uterine activity. And, secondly, sperm contains prostaglandins, which have a beneficial effect on the process of cervical maturation.

At what opening does pushing begin?

Pushing is a voluntary contraction of the abdominal muscles. The desire to push arises in women already at 8 cm. But until the cervix is ​​fully dilated (10 cm) and the head drops to the bottom of the pelvis (that is, it can be felt by a doctor by pressing on the labia), you cannot push.

Just before childbirth, the cervix changes dramatically. A pregnant woman does not feel these changes, but the unborn child gets a chance to be born naturally. So how exactly does this reproductive organ change and when is medical attention needed to improve the dilatation of the uterus? We are looking for answers to these and other similar questions.

Ideal cervix before childbirth

The parameters characterizing the state of the uterus before childbirth are its location in the pelvis, state of softness and length. The softening of the cervix to the point where it can allow 1-2 fingers of the doctor inside indicates the readiness of the birth canal for the process of delivery. Such changes are accompanied by the removal of the mucous plug. That is, the sooner the cervix begins to dilate, the sooner the woman in labor notices this sign of the onset of contractions.

Before childbirth, the cervix shortens. According to medical statistics, its length is about one centimeter. If we talk about the location, then it becomes in the center of the small pelvis, while during pregnancy the cervix is ​​tilted back.

Doctors evaluate all of the above parameters on a five-point scale. A score of 5 indicates that the uterus is ideally ready for childbirth. This condition is called a mature uterus.

Ways to stimulate cervical dilatation

The above are excellent prenatal parameters. But in practice this is not always the case, and doctors resort to stimulating the process of cervical dilatation.

If a medical examination shows that the cervix is ​​not mature, and you are due to give birth soon, then it is quite acceptable to perform this process and stimulation. Not using it sometimes means dooming the child, given the fact that before birth the placenta “grows old” and cannot cope with its functions as before.

In practice, stimulation is done in four ways, sometimes with a combination of them:

1. Sinestrol injections intramuscularly. The drug makes the cervix mature, but does not affect contractions.
2. Insertion of kelp sticks into the cervix. Such sticks, 5 cm long, are placed in. After a few hours, they swell under the influence of moisture and thus open the cervical canal.
3. Injection of a gel with prostaglandins into the cervical canal. This gel works quickly - and the neck opens in 2-3 hours.
4. Administration of Enzaprost intravenously. This drug also contains prostaglandins. Thus, the period of contractions is reduced in time.

Sometimes women use self-induction of labor.

Among them:

1. Enema. After it, the mucus plug comes off - and the cervix becomes mature. The procedure can only be used by women who have already reached their due date, that is, the baby is full-term.
2. A warm bath is not recommended if the plug and water have come off. The procedure is also dangerous for women with high blood pressure.
3. Sex acts as a medical stimulant, because sperm contains prostaglandins. That is, it promotes the maturity of the uterus. But pregnant women whose plug has already come out should not have sex. After all, there is a possibility of “catching” an infection in the uterus.
4. Physical activity. This could be a brisk walk, washing the floors, or cleaning. Women with hypertension do not need to overdo these methods.

But such methods can be fraught with dangerous consequences.

Stages of cervical dilatation

The cervix goes through several stages of dilatation before childbirth. The first is called latent or slow. It lasts 4-6 hours with a dilatation of up to 4 cm. In this case, contractions occur every 6-7 minutes.

The second stage is called active or fast. Every hour the cervix dilates by 1 cm. This continues up to 10 cm, and contractions occur every minute.

The third stage is full disclosure. It characterizes the process of the onset of labor. Sometimes the dilation of the cervix is ​​premature. This is evidence of pathology and, without treatment, can cause premature birth or miscarriage.

A pregnant woman should remember that in the period before childbirth she needs to be prepared for the fact that labor will begin earlier. If you feel unwell or have other symptoms, consult a doctor immediately.

Peace of mind and health to you!

Especially for Elena TOLOCHIK

The success of delivery depends on the productivity of the uterus. The normal functioning of her cervix is ​​due to a sufficient amount of hormones produced by the woman’s body. Throughout the entire period of gestation, this part of the reproductive system is tightly closed so that the pregnancy continues. If the dilation is 2 cm, how long before labor begins depends on the rate of cervical ripening, the expectant mother’s readiness for the birth process and the size of the fetus.

Stages and timing of childbirth

Childbirth begins with the preparation of all organs and systems for this important event; cervical ripening is one of them. This is the beginning of labor, which is rightfully considered the most painful period. Disclosure occurs in three stages. In the first stage, the cervical canal softens and smoothes. The second level represents an increase in the intensity of uterine contractions. The cervix dilates to 4-5 cm before childbirth. The third degree is the absolute expansion of the uterus by 10 fingers.

Cervical dilatation has two phases: latent (1st stage) and active (2-3). The initial level lasts about 6-7 hours for first-time mothers, and for repeat pregnancies - half as much - 3-4 hours. As soon as the canal has opened by 3 cm, labor enters the active stage. We can say that the cervix moves apart by about 1 cm every hour. That is, an opening of 2 cm does not mean that labor has developed into an active period. In the second phase, the baby himself begins to help. – with his weight he presses on the uterus and cervical canal, trying to insert the head into the small pelvis.

To determine the stage of readiness of the cervix for labor, you need to see a doctor. This occurs through an internal examination of the pregnant woman by an obstetrician in the maternity ward. If a section of the reproductive system is not ripe, it is closed, and as an additional protective agent, it is sealed with a mucous plug. At this stage, the neck is 2 cm long, but the organ is considered mature when it opens 1-2 fingers. This is how labor begins. During this period of time, the uterus gradually matures, the mother’s task is not to get confused and get ready for the maternity hospital.

Next comes the stage of contractions. The woman feels periodic petrification of her stomach. These are birth spasms. They should become frequent and regular. The third stage is full disclosure, it is characterized by the beginning of pushing, as a result of which babies are born.

Diagnostics

It is impossible to determine the degree of dilatation by the appearance of the abdomen or its palpation. The woman is examined by an obstetrician in the maternity ward. He conducts a gynecological examination, measures the length of the cervix, maturity and readiness for labor. If the uterus has dilated by 2 cm, the process of childbirth is at the initial level. A woman needs to be as positive as possible, learn to breathe correctly and massage the sacrum area.

When the uterus becomes soft, this is a sign of its readiness for the active phase of labor. With each uterine contraction there will be a slight dilatation. It is important to control the speed of the process. The doctor should periodically examine the expectant mother, recording the development of the opening of the uterus. When labor begins depends on how quickly contractions become regular. The softening and lengthening procedure should not stand still. To enhance labor and the opening of the uterus, it is recommended to move more around the room or corridor.

You can use a fitball to relieve pressure on the genitals and smooth the cervix. It is allowed to begin performing any manipulations in the delivery room after agreement with the obstetrician leading the birth. After all, the most important thing for a mother is not to harm her child.

It is necessary to control the duration of the canal maturation period. If this stage is too long, the baby suffers. Therefore, doctors are taking measures to speed up the birth process. Sometimes they resort to artificial stimulating procedures to avoid oxygen starvation of the fetus.

Symptoms of disclosure

As a rule, the female body tells what is happening in it. The dilatation of the uterus also has its own signs, by which the expectant mother can guess the onset of labor. These sensations cannot be confused with anything else.

Symptoms of cervical opening:

1. discomfort in the uterine area (a tingling feeling with a needle);
2. there is aching pain in the lower back and hips;
3. spasmodic abdominal pain;
4. discharge of the mucus plug.

All signs of the disclosure process are explainable. Pain begins to be felt when the length of the cervix is ​​2 cm. At this point, each contraction brings the woman closer to full dilation.

You need to try not to miss the initial degree in order to have time to get ready and get to the maternity hospital on time. Dilatation of 2 cm during the second birth occurs much faster. Therefore, it is better for multiparous women to stay in a hospital after 38 weeks, especially if it is far to get to the hospital. Early dilatation requires supportive drug therapy.

When to give birth if the cervix is ​​dilated by 2 cm? It is impossible to give a single correct answer, since everything is individual: for some it is a few hours, for others it is a couple of days. The point is in the woman in labor and the characteristics of her body.

Methods for stimulating opening

There are two types of influence on the reproductive system in order to open the uterus: stimulation with drugs and a non-drug option. Both methods of influencing the maturation activity of the cervical canal should be carried out strictly in a hospital setting, under the supervision of a physician. This is necessary due to the risk of rapid labor.

Drug therapy:

• administering medications directly into the cervix;
• use of prostaglandins (algae, kelp);
• puncture of the amniotic sac.

When special medications are prescribed, the effect occurs within 2-3 hours. A negative factor of the stimulation method is the pain of administering the medication.

The use of prostaglandins does not cause pain. The procedure involves inserting a tampon made from algae into the cervical canal. When moisture is absorbed from the genitals, the kelp stick swells and spreads the neck. The result occurs 5-6 hours after administration.
Amniotomy (puncture of the amniotic sac) also helps open the uterus. The mechanism of its action is the outpouring of water, after which the baby moves more actively towards the exit. The baby's head creates pressure on the cervix, and as a result, it opens.

Non-medicinal methods:

1. maternal motor activity after cervical dilation by 2 cm;
2. cleansing enema;
3. full sex life;
4. physical activity.

The enema has a smoothing effect on the back wall of the uterus. This action causes uterine contractions. This procedure accelerates the maturation process of the cervical canal.

How long it takes to give birth when the cervix is ​​dilated by 2 fingers depends on the correctness of stimulating measures. Untimely use of any method will cause complications and health difficulties for both the mother and her child.

Pathologies of early opening of the cervical canal

It happens that the cervix does not cope with its role of holding and protecting the fetus. As a result, premature birth or the threat of termination of pregnancy begins. This is called isthmic-cervical insufficiency. If the gestation period is too short, there is a danger to the baby's life.

Causes of pathology:

• frequent abortions;
• genital surgery;
• ruptures from previous births;
• multiple pregnancy;
• improper formation of the uterus;
• excess production of male hormones

Permanent abortions and curettages injure the neck. It becomes scarred and cannot fully cope with its function. A girl who has not given birth should remember this.

Operations and scars on the cervical canal for the same reason negatively affect the performance of the cervix. As a rule, injury to the genital organ occurs due to health reasons, so there is no prevention for it.

Multiple pregnancy may cause deficiency. The fact is that the cervix cannot withstand the pressure of two children and opens. Such expectant mothers should visit a gynecologist more often.

Sometimes the reason for early disclosure is abnormal structure of the reproductive system. As a rule, this is a congenital defect or the result of a serious injury. Here you just need to be vigilant and listen to yourself.

Excessive androgen secretion have a relaxing effect on the neck. The organ opens ahead of schedule. Before planning a pregnancy, such women should normalize their hormonal levels.

It is very important to become familiar with the signs of pathology during pregnancy so that you can stop the anomaly in time. Premature opening of the uterus can be diagnosed during a routine examination in consultation.

Symptoms:

1. pain;
2. removal of the plug or part thereof;
3. leakage of amniotic fluid;
4. hypertonicity of the uterus.

Treatment of the anomaly is carried out in two ways: surgical and medicinal. Sometimes even the usual restrictions on physical activity and the prescription of drugs that reduce uterine tone are enough to stop the dilatation process.

If the doctor sees a need, he will prescribe surgical procedures for the pregnant woman that affect the uterus. This is suturing the cervix or installing a pessary (support rings that take on the load, relaxing the cervical canal). This helps keep the mucus plug in place, thereby reducing the chance of infection of the fetus. Both options are effective and widely used in obstetric practice. They do a good job of protecting the child from premature birth. The choice of method depends on the stage of pregnancy. Cervical suturing is used up to 20 weeks, and a pessary is inserted later.

The dilation of the uterus is an important stage in the process of childbirth. The entire subsequent birth act, as well as its duration and success, depends on how this period of delivery goes. The state of health of the woman in labor at this stage of labor resembles painful menstruation.

It is forbidden to independently use methods to influence the speed of opening of the cervical canal; it is better to consult an obstetrician-gynecologist about this. Stimulant therapy requires medical supervision and is not always appropriate.

If the cervix opens early, you need to try to eliminate the pathology as quickly as possible so as not to harm the baby. This is done by suturing the cervical canal or installing a pessary, a ring to support the fetus. It is important to be aware of a possible anomaly even at the stage of pregnancy in order to respond to alarming symptoms in time.

At the very end of pregnancy, a woman’s body begins to prepare for childbirth. Dilation of the cervix by 2 fingers is one of the signals that the long-awaited meeting with the baby should happen very soon. However, this does not always mean that the process of future childbirth has already started and is proceeding correctly. There are various situations when obvious symptoms of dilation may indicate a pathological course of pregnancy and threaten the health and life of the fetus. To understand what signs indicate the approach of childbirth, you need to know the structure of the female reproductive system and the processes that occur with it as the child is born.

The uterus consists of 3 parts: the fundus, the body of the uterus and the cervix. It has a cervical canal that connects the body of this hollow muscular organ and the vagina. During pregnancy, the internal uterine os is tightly closed. This helps prevent premature birth and protect the baby from infections. An additional barrier to infection of the fetus from the outside is the mucus plug. Before childbirth, the ratio of hormones in a woman’s body changes dramatically. The main female hormone estrogen decreases, and the level of oxytocin and prostaglandins increases. It is these hormones that influence the preparation of the reproductive system for an early birth.

Before childbirth, natural preparation for the opening of the internal pharynx begins, laid down by nature. During normal pregnancy, these processes begin in the body at approximately 36-37 weeks. By 38 weeks of pregnancy, a number of serious transformations should have already occurred in the cervix. How labor will proceed largely depends on her degree of readiness for childbirth. The cervix, in which the necessary changes have occurred for the birth of a child, is called mature. Obstetricians identify the following signs:

• the uterus descends lower;
• the birth canal becomes softer and more elastic;
• the neck is smoothed out and shortened to about 1-2 cm, the entrance to it expands.

Symptoms of cervical dilatation by 1 cm, as a rule, occur without any peculiarities; the expectant mother does not experience any discomfort. Only a doctor can see the dilatation, which is at an early stage, during a routine examination of a pregnant woman. Such examinations in late pregnancy take place weekly. The dilatation of 1 finger is 1.5-2 cm. In women pregnant for the first time, this condition can persist for 10-14 days before birth and is not an indication for urgent hospitalization if all other indicators are normal and the gestational age is less than 40 weeks.

In multiparous women after 37-38 weeks, any symptoms of cervical dilatation may mean that labor will occur within a few hours, since labor can develop much faster than in primiparous women. If a woman is expecting her second child, then dilation of the uterine pharynx by 2 fingers means that she is in labor and hospitalization is necessary.

Finger measurements

Symptoms of uterine dilatation do not appear in any way at the first stage. To find out how ready the body is for childbirth, the woman is examined in a gynecological chair. This procedure includes visual and manual inspection. One of the ways to determine the degree of dilation, which is most accessible to an obstetrician-gynecologist, is to insert fingers into the cervical canal. The unit of measurement accepted in obstetric terminology is the width of the finger. The degree of cervical dilatation is deciphered as follows:

1. The dilation of 1 finger is 1.5-2 cm. It is typical for the preparatory stage for childbirth. It may be accompanied by a feeling of heaviness in the lower abdomen, mild and irregular aching pain in the lumbar region.
2. Two fingers freely passing into the cervical canal indicate the beginning of the active phase of labor, which is accompanied by regular contractions with equal intervals between them. The width of the cervical canal is already approximately 4 cm. The frequency of contractions at this stage is approximately 2-3 contractions per 10 minutes. The fetal head descends into the pelvic area and puts pressure on the uterus, causing it to contract more strongly. This process contributes to further opening of the pharynx, which reaches 8-10 cm by the beginning of the next stage of labor.
3. The dilation of 4-5 fingers is 8-10 cm and is complete. At this point, the body is ready to expel the fetus. This means that the baby will be born very soon.

After labor enters the active phase, starting from 2 fingers, cervical dilatation in women giving birth for the first time occurs by 1 cm per hour; in women expecting their second and subsequent children, this process occurs much faster.

Premature manifestation

Symptoms of uterine dilatation may indicate a pathology of pregnancy, which poses a danger to the fetus if the period is less than 38 weeks and the cervix is ​​open by 2 cm or more. In this case, the pregnant woman requires urgent hospitalization, as this condition can lead to premature birth. If the dilatation is 1 finger, then doctors usually prescribe drug therapy and complete rest. While the woman is in the hospital, the condition of the fetus is constantly checked, the heart rate is monitored using cardiotocography, and, if necessary, ultrasound diagnostics with Doppler ultrasound are performed.

When the cervix is ​​dilated by 2 fingers in women who are up to 34-35 weeks pregnant, doctors take emergency measures to stop premature birth. One way to stop the process that has begun is to apply sutures to the cervical canal. Another common method of stopping premature dilatation is the placement of a pessary.

These measures, in combination with taking medications and maintaining complete rest, make it possible to stop the onset of labor. Depending on the health of the expectant mother and the characteristics of the pregnancy, after taking emergency measures, a woman can carry the baby to term, despite a slight dilatation of the cervix.

Organ immaturity

But the opposite situation also happens, when the gestational age is 40-41 weeks, and symptoms of throat opening are partially or completely absent. This indicates the immaturity of the cervix and its unpreparedness for childbirth. This condition also poses a danger to the unborn child, since by 40 weeks the placenta exhausts its ability to deliver oxygen and nutrients to the fetus. Extended pregnancy can lead to hypoxia and even asphyxia of the baby.

There are many reasons why symptoms of cervical dilatation may be absent or false:

• structural features of the pelvic organs;
• severe stress that interferes with disclosure;
• lack of necessary hormones;
• severe muscle spasms;
• oligohydramnios;
• erosion;
• age over 35 years.

If the pregnancy is approaching the day of the expected birth, and the condition of the cervical canal indicates an unpreparedness for childbirth, then the attending physician may prescribe certain procedures and medications in order to speed up the process. There are several methods, medicinal and non-medicinal.

Non-drug methods of accelerating labor include:

• physical exercises that stimulate the expansion of the cervical canal and the opening of the uterine os (cleaning, long walks, climbing stairs);
• sexual intercourse (during sexual intercourse, blood circulation in the uterus increases, and seminal fluid contains a large number of prostaglandins, which affect the dilation of the cervix and provoke the onset of contractions);
• cleansing enema (provokes irritation of the posterior uterine wall, which causes expansion of the uterine pharynx).

These methods must be used with caution. After all, excessive physical activity can harm the child. Unprotected sexual intercourse after the mucus plug has passed can lead to infection of the fetus. Therefore, you should not decide on the need for such measures on your own. All actions must be coordinated with the gynecologist who is observing the woman during pregnancy.

Drug stimulation of labor

There are cases when there are symptoms of cervical dilatation, such as the passage of the mucous plug, regular contractions, rupture of amniotic fluid, but the os of the cervical canal allows no more than 1-2 fingers to pass through. This indicates weak labor and requires its stimulation with medications. In medicine, there are several ways to speed up labor:

1. Stimulation with tablets containing prostaglandins. This is one of the simplest ways to speed up disclosure. It is a method of preparation for childbirth, and not an emergency measure.
2. Insertion of a gel with synthetic prostaglandins into the vagina. The procedure is carried out several times a day, monitoring the condition of the patient and the fetus.
3. Kelp sticks. They are inserted into the cervical canal, where they swell and gradually mechanically open the cervix.
4. A Foley catheter also mechanically opens the uterine os and is considered the fastest way to prepare for labor.
5. A dropper with the hormone oxytocin. This method is used most often. Oxytocin stimulates labor. Under its influence, the opening occurs much faster, and the contractions become more intense.

If medications to induce labor do not produce results, the cervix does not dilate, and the baby’s life is at risk, doctors usually decide to perform an emergency caesarean section.

Symptoms of cervical dilatation cannot be ignored at any stage of pregnancy. A woman should immediately report any changes in her condition to her doctor. This will help prevent possible pathologies in time and take all measures to normalize the course of pregnancy and labor.

As pregnancy progresses, processes begin to occur in the uterus that involve partial replacement of muscle tissue with connective tissue. As a result, new collagen fibers are formed, which are more extensible and flexible than before pregnancy. Clinically, this process manifests itself in loosening and shortening of the cervix, as a result of which the cervical canal begins to gape in the later stages. It is in this way that the uterus is gradually prepared for the upcoming birth.

Already from 32-34 weeks, the cervix begins to prepare for childbirth. This is manifested in its softening along the periphery, but the area of ​​​​dense tissue lining the canal is still preserved.

In primiparous women, the cervix at this stage can only allow the tip of a finger to pass through, but in those women who give birth repeatedly, 1 finger can freely pass through the internal pharynx. So by 37-38 weeks the cervix is ​​almost completely softened. In this case, a woman may hear from a gynecologist that the cervix is ​​dilated by 2 fingers. At the same time, the fetus itself gradually begins to descend into the small pelvis, putting pressure on the neck with its weight, which contributes to its further opening.

It starts directly from its inner pharynx. Moreover, in primiparous women it takes the shape of a truncated cone, the base of which faces the top. Upon examination, the gynecologist says that the cervix is ​​short and the dilatation is 2 fingers. As the fetus moves into the pelvis, the external os of the uterus also stretches.

In women giving birth repeatedly, cervical dilatation usually occurs faster and easier. This happens because the external pharynx in such women by the end of pregnancy is already slightly open by 1 finger. That is why, often, the opening of the external and internal pharynx occurs almost simultaneously.

Immediately before a woman is about to give birth (3-5 days), the dilatation is 2 fingers, and the cervix is ​​smoothed and exhausted.

In cases where a doctor, when examining a pregnant woman in a gynecological chair, says that the cervix is ​​too long, despite the dilation of 2 transverse fingers, one cannot count on childbirth in the next 3 days.

A week before the expected date of birth, a woman, once again visiting a gynecologist, may find out that her cervix is ​​“immature” and needs artificial preparation for the birth process. This can also occur after the 40th week of pregnancy, i.e. when walking. Often the neck is slightly open (2 fingers wide), but not soft, i.e. fingers pass through the channel tightly.

The process itself can be carried out in 2 ways: medicinal and non-medicinal. As the name suggests, When implementing the first, various medications are used.

The second involves the use of various auxiliary means. So, quite often kelp sticks are used. They are inserted directly into the cervical canal, along its entire length. At the same time, the woman experiences painful sensations. After 4-5 hours from the moment of installation, they begin to swell and increase in size, thereby mechanically opening the canal. Also, in order to increase the dilation of the cervix, special tubes can be used, similar in appearance to a catheter, with a ball at the end. By pumping air, it inflates, thereby expanding the cervical canal, stimulating the onset of the birth process.