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 most common pregnancy pathologies is short neck uterus. In order to understand what kind of diagnosis this is, what this condition entails and how to treat it, our article is dedicated 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.

At gynecological examination the vaginal part of the cervix is ​​visible, which is assessed by the 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 cervical canal by 10 cm - during the birth process.

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

Causes of shortening of the cervix

ICI, or isthmic-cervical insufficiency, is pathological condition, which 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 later, 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. With the development of regular labor activity, premature rupture of amniotic fluid or bleeding, they are removed immediately.

Depending on the pathology that led to shortening of the cervix, appointments are made medicines individually for each pregnant woman.

Sexual life with ICN

If a pregnant woman has a short cervix, sexual activity is 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 with a suture placed on the cervix or an obstetric unloading pessary 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. Upon examination at 21 weeks of pregnancy: The cervix is ​​up to 1.5 cm long, softened, the external os is open up 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.

The cervix or cervical canal is a cylindrical organ that connects the uterine cavity to the vagina. Average length equals 3-4 cm. The holes present on the isthmus open when sperm are received, or for the release of menstrual blood.

What functions does it perform?

During pregnancy, the cervix performs the following functions:

1. Barrier. The cervical canal prevents pathogens from entering the uterine cavity;
2. Secretion production;
3. Participation in the reproductive system.

Pathologies of the cervix lead to the inability of the normal course of pregnancy. Such diseases include “shortening of the uterine isthmus.”

What does a short cervix mean during pregnancy?

A short cervix is ​​a shortening of the cervical canal due to several reasons. The required length of the CC contributes to the performance of the main functions of the pharynx. And shortening interferes with the gestational process.

The disease has no clinical signs. An obstetrician-gynecologist can identify it during an examination.

The course of pregnancy becomes much more complicated when the diagnosis is confirmed.

A change in the length of the pharynx downward is a threatening condition for the fetus.

Causes of pathology

• Abnormal structures of the pelvic organs, incl. underdevelopment of the isthmus canal;
• Pathological development of the uterus;
• Heredity by female line(from grandmother to mother, etc.);
• in the endocrine system during pregnancy;
• Hormonal disorders;
• as a result of childbirth, curettage of the walls of the uterine cavity, and other surgical interventions;
• Dysplasia of the epithelial layer;
• During pregnancy this may be;
• Multiple pregnancy or carrying a large child;
• Scars on the uterus;
• Polyhydramnios (the amount of amniotic fluid exceeding the norm).

It is possible to determine the cause through a thorough examination and history taking.

Shortening can be of two types:

1. A slight change in length - instead of the required 4 cm it may be 2.8, but not less than 2.5 cm;
2. Significant shortening of up to 2 cm or less.

A “short” cervical canal can be detected no earlier than 11 weeks of gestation.

Symptoms

In the absence of pregnancy, the woman has no idea about the presence of this pathology. Clinical manifestations the disease does not, which is the main danger.

Some women with short neck uteri reported the following symptoms:

• Painful sensations in the lower abdomen (not pulling);
• Minor discharge of a bloody nature;
• Watery mucous discharge.

These symptoms may indicate other pathological conditions, so you should consult a doctor for help.

Short cervix during pregnancy at 20 weeks is a dangerous period in bearing a baby. Having crossed the equator of gestation, the fetus begins to actively move. It has a physical effect on surrounding organs, including which, due to its shortness, is not able to hold the child.

A twenty-week-old baby is not viable in the extrauterine environment. In this case, he will not be able to survive.

Short cervix during pregnancy at 30 weeks- second dangerous period gestation. Multiple pregnancies and carrying a large child require special monitoring.

How is a short cervix diagnosed?

A gynecologist is able to identify the disease only after a personal examination in a gynecological chair and in the conclusion of an expert with cervicometry.

Diagnostic procedures to confirm the diagnosis include:

• Examination of the cervical canal using the “finger method”; the patency of the pharynx is also determined;
• Ultrasound diagnostics for detection;

Dangerous consequences of pathology

Shortening of the central circulation threatens with serious complications for both mother and child:

1. Increased risk of premature and;
2. Risk of fetal infection due to deterioration of cervical barrier function;
3. Habitual miscarriage on;
4. and trauma during obstetrics;
5. Hypoxia of the newborn, caused by leakage of amniotic fluid that does not hold due to a weakened pharynx.

Treatment

A short cervix is ​​not an indication for termination of pregnancy. The pathological condition is treatable. There are high-tech methods that help prolong pregnancy with such serious diagnoses.

Several factors influence the method of treatment:

Surgical methods

Stitching of the cervix (cervical canal cerclage).

The operation is performed no earlier than 14 and no later than 25 weeks. The cervix is ​​“sutured” to prevent its expansion;

Conservative treatment

1. - one of the most common methods. A special ring, selected according to an individual size, is placed on the cervical canal.
2. Drug treatment is indicated for mild organ shortening. Medicines are prescribed by the attending physician, who also selects the dosage.

Pharmaceuticals:

• Sedatives and sedatives;
• Hormone therapy (tablets and suppositories);
• Eliminating drugs (drugs, ginipral).

Drug treatment is aimed at maintaining pregnancy. That is, to prevent the risks of developing undesirable consequences.

Preservation of pregnancy with a short cervix

To maintain pregnancy and its normal course, a pregnant woman is recommended to follow bed rest. At severe course disease, hospitalization is indicated.

It is necessary to visit a gynecologist according to the established schedule and follow all prescriptions and recommendations.

When carrying a child, pregnant women with a short uterine cervix Avoid exposure to stress and anxiety.

If necessary, pass additional methods diagnostics:

Physical activity and excess worsens the situation. However, completely giving up exercise and going on a diet is not recommended.

Intimacy is not a contraindication for a short os. It should be limited if there are clinical symptoms and the first days after suturing.

Childbirth with identified pathology

If a diagnosis is made, the pregnant woman must go to the hospital before labor begins.

If a pessary was installed, doctors remove it, as well as stitches. In early gestation, pregnancy is prolonged. If the 38th week has approached, the pregnant woman is allowed to give birth.

Complicated labor or its rapid development should be under the supervision of doctors.

The doctor determines the tactics of treatment and obstetric care.

Prevention

Pathology of the cervix, or rather its shortening, cannot be prevented. But to reduce the severity of the disease during pregnancy or after it, it is important to follow some rules:

Medicines from of this kind there is no pathology. But vitamin therapy will not be a hindrance. For nervousness, magnesium supplements with vitamin B6 are indicated.

Video: k Short cervix during pregnancy

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, which 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 of the 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 buildings female body;
• - a consequence of 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 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 get more rest to eliminate the possibility. It is necessary to wear a bandage and avoid physical activity. These are 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. The procedure is performed 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 week 37, 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 the cerumen plug.

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 characteristics on the course of labor. 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.

The cervix is ​​a structure that is a continuation of the body of the uterus - its bottom part. The normal length is 4-5 centimeters outside of pregnancy. In the middle of the cervix there is an opening - the cervical canal. It connects the uterine cavity to the vagina. When carrying a child, it must remain closed, this prevents the fetus from being born prematurely.

Short cervix during pregnancy- a pathology in which this anatomical structure softens and decreases in length. These processes contribute to the opening of the cervical canal. Due to the described changes, there is a threat of miscarriage or premature onset of labor.

Norms for cervical length

From 16 to 20 weeks, the optimal cervical length is from 4.5 to 5 centimeters. At this time, shortening up to 3-3.5 centimeters is allowed. From 20 to 20, the physiological length of the cervix is ​​4 centimeters or more. Values ​​from 3 centimeters are within the normal range.

From 25 to 30 weeks of pregnancy, the normal length of the cervix ranges from 3.5 to 4 centimeters. It can be shortened to 2.5-3 centimeters. From 30 to 32 weeks of gestation, the optimal length of the cervix is ​​3.5 centimeters; within normal limits, its size is up to 2.5 centimeters.

From 32 to 32, the optimal length of the cervix is ​​3 centimeters, but it can be shortened to 2 centimeters. Later given period Hormonal changes occur in the female body, which prepares the woman for the upcoming birth.

Starting from the 38th week of pregnancy, the cervix begins to actively shorten. This process promotes the opening of the uterine pharynx and the onset of labor. IN last days During gestation, the normal length of the cervix is ​​less than 2 centimeters; with the onset of contractions, the anatomical structure is completely smoothed out.

Causes of shortening of the cervix

A short cervix may be a consequence congenital features woman's body. But much more often, pathology is observed under the influence of unfavorable factors:

• increased production of androgens - testosterone and its derivatives;
• decreased synthesis of progesterone, which supports pregnancy;
• reduced synthesis of estrogens - female sex hormones;
• trauma in previous births;
• more than 3 births;
• sexually transmitted infections;
• uterine bleeding;
• cervical injury during abortion;
• large size of the unborn child;
• multiple pregnancy;
• change in the amount of amniotic fluid (polyhydramnios or oligohydramnios).

The danger of a shortened cervix

The main danger of shortening the cervix is ​​the development of isthmic-cervical insufficiency, or ICI for short. This diagnosis can be made when the length of the anatomical formation is less than 20 millimeters. At ICN neck unable to hold the unborn child and its membranes in the uterine cavity.

Isthmic-cervical insufficiency is accompanied by softening of the cervix, due to which the internal and external pharynx can open at any time. The consequence of these events is the activation of contractions and the premature birth of the child.

Childbirth with a short cervix often does not proceed physiologically. Normally, the duration of contractions in a primiparous woman is about 12 hours, in a multiparous woman - about 9 hours. The long and gradual course of labor protects the uterus and its cervix from ruptures and other injuries.

With isthmic-cervical insufficiency, quite often labor takes on a rapid nature and lasts from 2 to 6 hours. Excessively violent contractions can cause fetal hypoxia (its oxygen starvation) and injuries to the internal genital organs.

Most often, during excessively violent labor, cervical ruptures are observed. They are caused by pushing the baby too early birth canal, while the cervical canal is not sufficiently opened. Severe cervical ruptures can spread to the lower segment of the uterus, which is a serious birth injury and requires surgical intervention.

The most dangerous complication rapid labor is uterine rupture. It can lead to painful shock, heavy bleeding and fetal death. If the uterus is completely ruptured, it may be necessary to remove it. On modern stage medicine this complication is very rare.

A very short and soft cervix during pregnancy may be a factor intrauterine infection fetus Normally, the vagina is not a sterile environment; it constantly contains a variety of microorganisms. In severe ICI, the amniotic sac “sees through” and even protrudes from the external uterine os, which facilitates the transfer of bacteria to the fetal membranes.

Intrauterine infection of the fetus is an extremely dangerous complication. On early stages it often causes the death of the unborn child and. Sometimes a miscarriage does not occur; the dead fetus remains in the uterine cavity and leads to infection. At later stages, infection of the unborn child leads to the development of severe anomalies, often incompatible with life.

How long should the cervix be during pregnancy? Gynecologist Lyudmila Shupenyuk answers:

Symptoms of a short cervix

Symptoms of shortening appear only from the middle of the 2nd trimester, when the fetus is actively growing. Due to an increase in its mass, the cervical canal may open, which will manifest itself with the following signs:

• unpleasant sensations in the lower abdomen, lower back, sometimes reaching cramping pain;
• feeling of heaviness in the vagina;
• clear, abundant uterine discharge;
• vaginal discharge with red streaks;
• red or brown uterine discharge.

The cause of these symptoms is a threatened or incipient miscarriage or premature birth. Therefore, if these signs are detected, a woman is advised to immediately seek medical help.

Diagnostics

If a shortening of the cervix is ​​suspected, the doctor should carefully collect a vital history. The doctor pays attention to cases of inadequate pregnancy, ruptures, and abortions.

Next, the doctor performs a digital examination of the vagina. With its help, the obstetrician-gynecologist identifies the patency of the cervical canal. The specialist then conducts a visual inspection of the vagina using speculums. This procedure helps to see the condition of the external uterine os and the presence of protrusion of the membranes.

The “gold standard” for diagnosing ICI is ultrasound. The doctor can examine the first signs of shortening with an abdominal ultrasound (through the anterior abdominal wall) at the first and second screening (according to the screening calendar, these studies are carried out at 11-12 and 21-22 weeks of pregnancy).

If there is any doubt, the obstetrician-gynecologist should conduct a vaginal ultrasound examination; it allows making a final diagnosis. After detecting shortening expectant mother requires close monitoring throughout the subsequent pregnancy. Usually the doctor prescribes a control vaginal examination ultrasound examination every 2-4 weeks.

Treatment of a short cervix

For endocrine etiology of pathology, doctors prescribe hormonal treatment. It includes progesterone preparations (Duphaston, Utrozhestan). Listed medicines help maintain pregnancy by relaxing the tone of the uterus and closing the cervical canal. With medication hormonal treatment You should donate blood for gestagens and androgens at regular intervals.

For non-hormonal etiology of isthmic-cervical insufficiency, non-surgical and surgical methods treatment. The first type includes a ring that is inserted onto the cervix and protects it from further dilatation. This method Treatment is indicated from the 28th week of gestation. Contraindications for its use are prolapse of amniotic membranes and severe disease.

Before installing an obstetric ring on the cervix, you must ensure that there is no inflammation. If available, you should mandatory carry out antibacterial treatment. A woman who has a pessary on her neck should visit the doctor every 14 days to disinfect the ring, which will prevent the development of inflammation. Before childbirth, this device is removed.

Attention! Often a short cervix does not manifest itself during pregnancy, so expectant mothers should never miss routine examinations obstetrician-gynecologist.

Surgical treatment of isthmic-cervical insufficiency consists of applying U-shaped sutures to the cervix. It is indicated for severe and progressive opening of the cervical canal. This treatment method is contraindicated in inflammatory processes in the pelvis uterine bleeding, diagnosed congenital anomalies fetus

Sutures are placed under general anesthesia up to 28 weeks of gestational age. IN postoperative period must be taken antibacterial agents to prevent infection. Sutures should be removed at 38 weeks of pregnancy.

Expectant mothers with a short cervix are advised to follow the regimen. Women are prohibited from showing excessive physical activity, engage in active sports. It is advisable to exclude sex life and emotional stress.

Prevention

Prevention of cervical shortening includes healthy image life before conception. Women should plan their pregnancies carefully, avoiding medical abortions, which provoke structural changes in the internal genital organs. It is also recommended that expectant mothers donate blood for function tests. endocrine system before planned conception. Increased quantity male and reduced synthesis of female sex hormones requires medical adjustment.

During childbirth, the expectant mother should listen carefully to the doctor and midwife, and not push ahead of time, so as not to provoke cervical ruptures. Injuries to the organ contribute to the development of isthmic-cervical insufficiency during subsequent pregnancies. A woman is advised to be selective in sexual relations and to protect herself with non-regular partners. Inflammatory diseases urogenital system can cause structural changes cervix.

Not every pregnancy goes flawlessly, so most women sooner or later hear from their doctor about the threat of miscarriage. Basically, this diagnosis is made when the cervix is ​​shortened. What does the diagnosis of “short cervix” mean during pregnancy, why does it shorten and what is the danger of this pathology? These are common questions that arise in pregnant women when a narrow cervix is ​​detected and require detailed explanation.

Cervical length during pregnancy: what does it affect and what does it depend on?

U different women the length of the cervix varies, and this depends largely on individual characteristics the structure of the female body or other factors:

• operations;
• abortions;
• hormonal imbalances in the body;
• some diseases;
• taking medications, including contraceptives.

However, after conception and implantation of the embryo, it lengthens and becomes shorter towards the end of pregnancy. What does this affect?

At normal pregnancy the fetus attaches and develops in the uterine cavity. A protective barrier against infection is the cervix formed by muscle tissue with a narrow cervical canal inside. During pregnancy, under the influence of hormones, a mucous plug is formed in it, which prevents microorganisms from entering and infecting the fetus. Usually, the presence of a short cervix does not cause any inconvenience to a woman and does not have a significant severe symptoms, so many do not even suspect that they have a pathology.

The problem becomes significant when a woman's body develops new life. The main task of the cervix becomes not only a barrier protective function, it is entrusted with maintaining pregnancy, that is, keeping the fetus inside the uterus until birth. As the baby grows in size, it puts pressure on the walls and cervix, which in turn can cause it to shrink and dilate. This can cause spontaneous abortion in the early stages or premature birth in later stages.

How is the length of the neck determined and what should it be normally?

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Each body is individual, and the size of the cervix will vary among women, but during pregnancy, under the influence of certain hormones, its indicators in most pregnant women become almost the same. In this regard, specialists accept average indicators for orientation and control of its condition, therefore any deviations from the norm are considered to be pathology.

If a woman has a short cervix or too long, she will not feel it at all, since with such a pathology there are usually no symptoms. However, during pregnancy every expectant mother She must undergo an examination, as a result of which the doctor can determine that she has a shortened cervix.

The doctor may notice that a woman has a short cervix during a vaginal examination. However, the final diagnosis will be made only if there is data from an ultrasound examination, which the pregnant woman undergoes at least 3 times during the entire period. It is ultrasound diagnostics that allows us to identify pathology.

At ultrasound examination The doctor looks at the size of the cervix starting from the 12th week. Until week 20, its normal range is 40–45 mm. In the second trimester, the fetus begins to grow rapidly and gain weight. The pressure on the cervix increases, and it shortens slightly - up to 30–40 mm. From 30–32 weeks, the normal length is 30–35 mm. Closer to childbirth, it may shorten, and at 38 weeks it reaches 2 cm.

If at these times a woman’s length and size differ from the norm, then it would be appropriate to talk about the presence of a pathology. When the organ is shortened, the pregnant woman should be under constant supervision. It is possible to diagnose ICI (isthmic-cervical insufficiency).

Can the indicator increase or decrease?

The question of whether the cervix can decrease and then increase, and what this depends on, is especially relevant for those who have a small cervix. Pregnancy is a time full of surprises, so there are often cases when a woman’s shortened cervix can quickly lengthen and vice versa.

This depends mainly on the state of health of the pregnant woman, her lifestyle and individual characteristics. If a woman is healthy, the cervix may become short due to severe physical activity, and after have a good rest lengthen again. If you have an ICN, you won’t be able to lengthen it yourself (we recommend reading:). These women are usually hospitalized and treated under observation.

Is there a way to lengthen the cervix?

If a pregnant woman has a shortened cervix, she must understand the dangers of this and approach the problem responsibly, since not only her health, but also her life is at stake. born child. She must follow all the instructions of the doctor who will prescribe the treatment. For minor shortening, to enlarge the cervix, they may prescribe sedatives, antispasmodics to relieve uterine tone, magnesium preparations, a complex of vitamins. A woman with a short neck needs to rest more, taking a comfortable lying position.

If a pregnant woman's cervix has significantly shortened, and there are also signs of spontaneous abortion or premature birth (contractions, nagging pain in the lower back and lower abdomen, spotting or bleeding), she urgently needs to be hospitalized. With timely treatment, doctors are usually able to enlarge the cervix and save the child.

Features of pregnancy with a shortened cervix

What should pregnant women do if they have a small cervix? Significant deviation can be dangerous. If there are indications for hospitalization, it means that treatment will have to be done in a hospital.

In most expectant mothers, the cervix becomes short due to insufficient production of progesterone by the body. In the case of isthmic-cervical insufficiency and significant shortening of the cervix, the woman is prescribed hormonal therapy. One of the common drugs that has proven itself is Utrozhestan. However, it must be taken only as directed and in a specific regimen prescribed by a doctor.

This remedy can be used throughout pregnancy and is gradually discontinued by the 36th week. Abruptly stopping the drug can significantly reduce progesterone levels and provoke signs of ICI. This condition is very dangerous and can lead to shortening and full dilatation of the cervix. When a woman feels unwell while taking this remedy, it is necessary to consult a doctor who will adjust the dosage.

Except hormone therapy In the hospital, Magnesia and Ginipral are administered intravenously, which help relieve tone and enlarge the cervix (more details in the article:). If it can be restored, the pregnant woman can have the uterus sutured or a pessary placed on it.

Surgical treatment is effective from 13 to 27 weeks. Indications for intervention may include pathologies of the cervix, its dilatation, the threat of premature birth or spontaneous abortion.

This operation is aimed at mechanically narrowing the pharynx and walls of the cervix and applying sutures, which helps it overcome the load and not dilate. However, this procedure also has contraindications. Surgery contraindicated:

• pregnant women with mental illness or genetic abnormalities;
• in the presence of intrauterine malformations in the fetus;
• with bleeding;
• with increased excitability of the mother;
• for diseases cardiovascular system, liver or kidney disease.

Women with a pathological structure of the uterine organs must take precautions to help maintain pregnancy. If a problem is detected in a pregnant woman, certain rules should be followed:

• eat right by consuming healthy food, rich in vitamins and microelements;
• avoid heavy physical activity;
• as prescribed, stay in bed;
• relax in supine position up to 5–6 times a day;
• take evening walks;
• reduce sexual activity, and if there are obvious contraindications, refuse intimate life before the baby is born (see also:);
• follow the schedule of visits established by the attending physician to monitor the condition, follow all his recommendations and seek help at the slightest ailment.

Shortening of the cervix before childbirth

Before childbirth, the cervix undergoes significant changes, and the doctor can judge its readiness based on several parameters:

1. Density. This parameter is determined during examination of the pregnant woman and palpation. When ready to give birth, it should become soft. The density and hardness of the organ being examined indicates its unpreparedness for childbirth.
2. Length. The action of hormones before childbirth allows you to shorten the cervix to 10–20 mm. Excess this indicator indicates unpreparedness for childbirth.
3. Location. When ready to give birth, she leans forward.
4. Patency. This indicator is determined by the size of the cervical canal (how many fingers the throat has opened).