Pregnancy is at risk, or how to deal with isthmic-cervical insufficiency. Istomico-cervical insufficiency: features of pregnancy and childbirth

A short cervix is not a sentence for a woman, however, when planning a pregnancy, such a pathology should not be ignored. The fact is that it is precisely because of the shortened neck (the length of which is less than 2.5-2 cm) that the process of bearing a child can proceed with very serious complications, the main of which is cervical insufficiency. Such a problem often causes a threat of termination of pregnancy or premature (transient) birth.

What to do if the cervix is short? First of all, strictly follow all the recommendations and prescriptions of the doctor aimed at maintaining pregnancy. Unfortunately, this pathology most often it is detected precisely during the period of bearing a baby, during a gynecological examination, and is confirmed by the conclusion of an ultrasound scan during an intravaginal examination.

In the presence of such a problem, a woman may face an inability to normal gestation and childbirth without medical intervention. normal neck has a length of approximately 4 cm. If in I-II trimesters its shortening to 2-3 cm is observed, we can talk about the development of isthmic cervical insufficiency. This condition is characterized by softening and expansion of the sphincter, as a result of which the first section may open. birth canal, and this is fraught with premature birth.

The congenital form of CI is most often associated with a genetic predisposition or individual structural features female body. The acquired nature of this pathological condition may be a consequence of medical and spontaneous abortions (miscarriages), previous births that were complicated by injuries (ruptures), as well as surgical interventions in the uterine cavity and other factors that somehow lead to trauma to the cervix and its deformation , scarring, etc. Thus, a future mother with a diagnosis of "short cervix" must follow the instructions of a gynecologist, and, if necessary, undergo treatment in a hospital in order to maintain pregnancy.

Drug treatment of a short cervix

If a pregnant woman is diagnosed with a "short cervix", the doctor prescribes treatment based on specific situation. It is necessary to take into account the condition of the pregnant woman, the length of the neck, comorbidities, research results and diagnostic measures. To avoid possible consequences, it is important to carry out early prevention diseases: visit a gynecologist in a timely manner, use reliable methods of contraception, reasonably plan a pregnancy.

The drugs prescribed for therapy will depend on the causes that provoked the pathology. First of all, a pregnant woman needs to take a blood test to determine the level of hormones. If the reason for the shortening of the neck is in hormonal failure, the danger can be eliminated with the help of hormone therapy. A pregnant woman is prescribed drugs of the glucocorticoid series: Microfollin, human chorionic gonadotropin, Turinal, Dexamethasone, etc.).

With minor changes in the neck, a conservative method is used, which consists in intravenous administration Ginipral or Magnesia. These drugs eliminate the tone of the uterus. Other drugs include sedatives (motherwort, valerian), multivitamins, and drugs that relax the smooth muscles of the uterus. Few weeks intensive care give positive result, and the condition of the cervix stabilizes. If the problem persists, surgical correction (suturing) is used, or an obstetric pessary is used to hold the uterus in the correct position.

If due to short neck developed isthmic-cervical insufficiency, the expectant mother is prescribed tocolytics - drugs that help relax the uterus (b-agonists, magnesium sulfate, indomethacin). In order to prevent placental insufficiency, vasodilators and vasoactive drugs, as well as low molecular weight dextrans. TO non-drug methods therapy can include acupuncture, electrorelaxation of the uterus, electroanalgesia, endonasal galvanization.

Utrozhestan

A short cervix during pregnancy is often a factor provoking the threat of miscarriage. If, against the background of a hormonal failure, the condition worsens, the expectant mother is prescribed drugs whose action is aimed at reducing contractile activity uterus.

Utrozhestan is one of these drugs (available in the form of capsules and vaginal suppositories). Its purpose is associated with a situation when the body of a pregnant woman experiences insufficient production of the hormone progesterone. Dosage this medicine is selected in each case individually, based on the symptoms of the threat of interruption and the degree of their severity. The usual dose is 200 to 400 mg/day. every 12 hours. The drug is contraindicated in liver diseases and varicose veins veins.

IN modern medicine the use of Utrozhestan is widely practiced with the threat of miscarriage due to a lack of progesterone. Therefore, a pregnant woman should not worry that this hormonal drug can harm her health or adversely affect the development of the fetus. On the contrary, this drug is necessary, and if it is taken in accordance with the doctor's prescription, then no side effects will not be. Moreover, this natural progesterone is obtained from vegetable raw materials. In the first trimester, intravaginal use of the drug is recommended, however, when used vaginally, the drug is absorbed faster and is better tolerated by the body.

Ginipral

A short cervix often provokes unforeseen complications during pregnancy (ICN, increased uterine tone, infection of the fetus), so it is important to identify the pathology in time and avoid serious problems.

Ginipral is prescribed to a future mother if she has uterine hypertonicity. This condition not only increases the risk of miscarriage or premature birth, but also "slows down" the flow nutrients and oxygen to the fetus. The drug is available in tablet form or in the form of injections and has a direct effect on the vessels of the uterus, contributing to a "soft" relaxation reproductive organ. It should be noted that in the first trimester, taking this medicinal product contraindicated. Its appointment is possible only after the 16th week, and the doctor determines the dosage and duration of administration. This requires control over blood pressure and blood sugar levels. If a pregnant woman has strong tone uterus, the dose of Ginipral can reach 500 mcg when taken every 3 hours.

Of the contraindications, one can also note individual intolerance drug components, hyperfunction thyroid gland, glaucoma, bronchial asthma, heart disease, kidney and liver failure. Side effects associated with the use of this medication include headaches, palpitations, agitation, and dizziness. Therefore, along with Ginipral, drugs are prescribed whose action is aimed at reducing cardiac activity. In order to avoid swelling of the pregnant woman, it is recommended to limit the intake of fluid and salt. Cancellation of the drug is carried out gradually, the dose is reduced at each dose.

Magnesia

A short cervix is a factor in the development of isthmic-cervical insufficiency, which means that a pregnant woman is threatened with spontaneous miscarriage or the onset of premature birth. When a pathology is detected, it is necessary to prescribe medications, the action of which is aimed at eliminating main problem- uterine hypertonicity.

Magnesia (magnesium sulfate) - effective drug, which helps prevent various complications with the threat of abortion. Its action is aimed at relaxation muscular musculature and walls of blood vessels, normalization of pressure, accelerated elimination body fluids. The effectiveness of this drug is manifested only with intramuscular and intravenous administration. Reception in the form of a powder will not give the desired result, since the drug will not enter the bloodstream from the intestinal tract.

The use of the drug is contraindicated before childbirth and in the first trimester of pregnancy. At later stages of bearing a child, such treatment should take place exclusively in a hospital, under the strict supervision of the attending physician. The dosage of magnesia will depend on the situation, i.e. the health of the pregnant woman, and comorbidities. Usually, usual reception 25% of the drug is 1-2 times a day, with the second stage of nephropathy - 4 times. It should be noted that the introduction of magnesia is a very painful process, requiring the experience and skill of a medical specialist.

Of the side effects that may occur as a result of taking magnesium, it should be noted weakness, drowsiness, anxiety, headaches, sweating, hypotension, speech disturbance. With low blood pressure, the drug can not be prescribed. In addition, it is not allowed to combine it with biological food additives and calcium preparations. Since taking this medication is associated with some risk, before starting treatment, the doctor will weigh the pros and cons, taking into account the specific situation.

Duphaston with a short cervix

A short cervix can be a prerequisite for a threatened miscarriage, especially against the background of hormonal changes female body during pregnancy. In particular, this is due to a lack of progesterone, confirmed by laboratory tests.

Duphaston with a short cervix is used if a pregnant woman has problems with bearing a child, and she has uterine hypertonicity. This drug is a synthetic analogue of the hormone, but in structure it is close to the natural progesterone produced in the body of a woman. The effectiveness and safety of the drug (especially in the early stages, up to 16 weeks) has been proven by many years of its use. positive property the drug is a sparing effect on the liver and blood clotting. The treatment regimen and dosage of Duphaston should be selected by the doctor on an individual basis, based on clinical picture and the patient's condition.

Usually, with the threat of miscarriage, the dosage of the drug is 40 mg once, and then reduced to 10 mg every 8 hours. Therapy continues until the symptoms disappear completely. If, after discontinuation of Duphaston, symptoms recur, it is necessary to continue therapy, returning to the optimal dosage.

Alternative treatment

A short cervix is a pathology that can lead to such dangerous state during pregnancy, as isthmic-cervical insufficiency. At the same time, the internal cervical pharynx is not able to cope with the "obturator" function, and it is more difficult for the uterus to keep the growing fetus in its cavity. Under pressure, there is an even greater shortening and opening of the cervix, which provokes the threat of miscarriage or premature (most often rapid) childbirth. In addition, due to the deformed neck, favorable conditions for infection penetration.

Alternative treatment for threatened miscarriage should be used with extreme caution, only after consultation with your doctor. In this case, effective means are:

A decoction of the bark of viburnum. One teaspoon of crushed viburnum root is poured with a glass of boiling water, put on a slow fire and removed after 5 minutes. After the broth is infused, you can start taking: 1-2 tbsp. spoons of funds during the day. You can also use viburnum flowers by taking approximately 30 grams of raw material and pouring it with 1.5 liters of boiling water. The decoction is infused in a thermos for about 2 hours, then taken ¼ cup 3-4 times a day.

Dandelion decoction. A pinch of grass (5-10 g) should be poured with a glass of boiling water and boiled a little. Use finished product¼ cup is recommended several times a day. In the same dosages, you can use dandelion root.

A good remedy is an infusion made from calendula flowers and St. John's wort. The ingredients must be taken in equal proportions and pour 200 g of boiling water, then insist in a thermos for half an hour. Ready infusion should be consumed throughout the day for 2 cups (you can add honey to taste).

Herbal treatment

A diagnosis such as a short cervix, if it is established during pregnancy, requires urgent methods to solve the problem, i.e. prescribing effective therapy aimed at preventing the threat of abortion. In addition to drugs that a gynecologist should prescribe (self-medication is excluded), herbs are often used that have a beneficial effect on the condition of the cervix and lower the tone of the uterus.

Herbal treatment should be strictly under the supervision of a doctor and with his permission, since some plants can have the opposite effect and harm the expectant mother and her child. Their herbs, which have proven their positive effect on the cervix, in particular, its preparation for childbirth, can be distinguished by evening primrose (plant oil). This remedy is available in capsules and is most often prescribed to a pregnant woman from the 36th week. The plant promotes the synthesis of estrogen and testosterone, and also stimulates the production of prostaglandins. In addition, it is rich in useful fatty acids(especially gamma-linolenic), which contributes to the elasticity of the cervix, as well as the prevention of its rupture during childbirth. Reception of primrose in the form of capsules is carried out in 2 pcs. per day, but from the 39th week, you can gradually increase the dose to 3 capsules.

Herbal decoctions (calendula, St. medicines. A good effect is given by tea made from raspberry leaves, which is recommended to be taken ½ cup before meals. Infusions of hawthorn and wild rose should be consumed in the morning, on an empty stomach.

No less useful is a decoction of strawberries, for the preparation of which you need to take 100 grams of berries and, together with chopped dry leaves, pour 1 liter of boiling water. Then the broth is brought to a boil and boiled for 30 minutes, filtered, cooled and taken during the day for half a glass (at least 1 liter).

Homeopathy

A short cervix during pregnancy can cause a lot of trouble for the expectant mother, one of which is ICI, leading to the threat of miscarriage or rapid delivery(at a later date). Along with drug therapy apply the use of various homeopathic medicines, however, their appointment should be carried out under the strict supervision of a physician and only according to his instructions.

Homeopathy, aimed at preventing the threat of miscarriage and improving the condition of the uterus, includes taking the following drugs:

Arnica - used in complex treatment with the development of isthmic-cervical insufficiency and the threat of termination of pregnancy; improves blood circulation of the pelvic organs;
Aconite - usually combined with other remedies for fear and anxiety, an accelerated pulse that accompanies CCI, has a calming effect on nervous system;
Arsenicum album is an effective remedy that helps with the body's tendency to miscarriage and is used to prevent recurrent miscarriage;
Chininum arsenicosum - this remedy has a good immunomodulatory effect and is prescribed for miscarriage and the threat of miscarriage due to infection of the genital tract, including due to a short neck;
Sabina - the drug is indicated to prevent miscarriage, more often in the early stages (8-12 weeks);
Zincum valerianicum - this remedy is used for hyperestrogenism, because. enhances the secretion of the hormone progesterone.

In addition to the above homeopathic remedies, a pregnant woman can be prescribed Calcium carbonicum, Sulfur, Silicea (as auxiliary drugs if the therapy is ineffective). When prescribing homeopathy, the anamnesis is taken into account, as well as the features of the constitutional type of the patient.

Surgical treatment of a short cervix

A short cervix diagnosed in a pregnant woman may require surgical intervention, especially when the threat of termination of pregnancy increases, i.e. there is a pronounced, progressive isthmic-cervical insufficiency.

Surgical treatment includes the use of the following methods:

mechanical narrowing of the uterine internal pharynx (more gentle method);
sewing up the external pharynx (imposition of a circular seam);
neck narrowing by strengthening its muscles along the side walls.

The main indications for the above manipulations are cases of premature birth and miscarriages in history, as well as progressive insufficiency. uterine cervix, i.e. its constant softening and shortening.

The main contraindications for surgical treatment can serve:

increased excitability (not amenable to correction) of the uterine walls;
various diseases internal organs(liver, kidney, heart);
genetic, mental illness;
bleeding during pregnancy;
the presence of malformations in the fetus.

Operations are most expediently carried out in the period from the 13th to the 27th week. In order to prevent the ascent of the infection, interventions can be carried out at the stage from 7 to 13 weeks. If there are contraindications, the pregnant woman is prescribed conservative therapy(drug reduction of uterine excitability), bed rest is recommended.

Bandage for a short cervix

A short cervix is not a sentence, however, during the bearing of a baby, it is advisable to prevent the development of isthmic-cervical insufficiency in order to maintain pregnancy. Many women are interested in whether it is possible to wear a bandage in this case.

A bandage with a short cervix is indicated when the expectant mother has uterine hypertonicity against the background of a shortened cervix, which is physiologically unable to hold the pressure of the uterus with a growing fetus. The fact is that a high tone of the uterine muscles can provoke premature maturation of the cervix. This is fraught with its softening and disclosure, as well as an increased risk of premature birth or miscarriage. In such cases, the pregnant woman is recommended to completely refrain from any physical activity and wear a special device - a supporting bandage.

It must be worn correctly, without squeezing the tummy. Thanks to this proven tool, it is possible to prevent early descent of the fetus, as well as ensure it correct location in the uterine cavity. In addition, modern bandages help a woman prevent the appearance of stretch marks, remove physical fatigue, facilitate walking, avoid overwork and heaviness in the body. A well-designed brace is able to relieve excess stress from the spine and prevent the occurrence of lower back pain.

There are practically no contraindications to the use of such a device, however, a doctor's consultation is mandatory. Usually, the use of a bandage is recommended for expectant mothers at 4-5 months of pregnancy, when the tummy begins to increase in size, and the pressure of the fetus on the short cervix increases every day.

Ring with a short cervix

A short cervix can cause many problems for a woman carrying a baby. This is due to the constant pressure of the uterus on the cervix due to the growing fetus. As a result of softening and even greater shortening of this organ, isthmic-cervical insufficiency may occur, i.e. threatened miscarriage. In especially severe cases, medical practice applied special device- so-called. "obstetric pessary". In this case, a procedure called "non-surgical cerclage" is performed.

The ring with a short cervix is most often used for a period of 25 weeks, when suturing the cervix is contraindicated for a pregnant woman in order to avoid injury to the fetal bladder and infection of the fetus. An analogy can be drawn between a pessary and a bandage, since both devices are designed to reduce the pressure of the uterus on the cervix and thus reduce the risk of infection of the fetus by preserving the sulfur plug.

For prevention infectious complications the vagina and the installed pessary are treated with special antiseptics every 15 days. This design is removed at the 37-38th week of pregnancy.

There is also an unloading pessary called the Meyer ring. This tool is made of plastic and has special form. It is inserted into the vagina to support the cervix, as well as to redistribute the weight of the fetus. This is one of the most effective methods treatment of ICI, allowing you to save the pregnancy. The Meyer ring is installed at any time when the condition of the pregnant woman is not aggravated by other pathologies, and the ICI is not running. Otherwise this method treatment can only be applied as an auxiliary.

Exercises for a short cervix

A short cervix is a problem for a pregnant woman, because due to the small length (2.5-2 cm) of this organ, isthmic-cervical insufficiency can develop when the cervix softens and opens, provoking a threat of abortion. In this case, the woman is assigned special therapy aimed at maintaining pregnancy. She is advised to limit physical activity and stick bed rest(in especially dangerous cases).

Exercises for a short cervix can only be prescribed by the attending physician, since with such a pathology one must be as careful as possible so as not to provoke premature opening of the cervix. Pregnant women should always consult with their doctor regarding exercise, their types and frequency of execution.

If the expectant mother has uterine hypertonicity, low blood pressure, varicose veins, and there is also a threat of miscarriage due to a short neck, gymnastics is contraindicated. In such situations, it is advisable to perform breathing exercises. In especially severe cases, when the threat of termination of pregnancy increases, any physical exercise because they can cause the most dangerous consequences(miscarriage, premature birth).

Today, many pregnant women practice Kegel exercises aimed at physical training muscles of the perineum and neck to labor. These exercises can be performed only with the permission of a gynecologist who will objectively assess the situation and the health of the expectant mother. The essence of Kegel exercises is to tighten the muscles of the vagina. The technique is simple: sitting on a chair, you need to slightly tilt the body forward, and then squeeze and unclench the muscles of the vagina 10 times. To do such a simple, but effective gymnastics should be 2-3 times a day.

Every woman dreams of having a normal pregnancy without pathological abnormalities and complications. However, there are often cases of miscarriage. The main reason for this may be isthmic-cervical insufficiency (ICI).
Content:

How does cervical insufficiency develop?

During pregnancy, the uterus increases in size due to its smooth muscle. The fetus develops in the body. The cervix is the part of the body that connects the vagina and uterus. Between the body and the cervix on the border there is a narrow zone called the isthmus.

The neck and isthmus are composed of connective and muscular tissues. At the internal pharynx there are muscles that form a kind of ring. In a normal pregnancy, this ring keeps the fetal egg in the uterus and prevents the growing baby from being born ahead of time.

It often happens that the obturator function of the uterus is disturbed and the cervix and isthmus cannot hold the fetus. There are various reasons for this. Such pathological condition is called isthmic-cervical insufficiency (ICI).

Deficiency occurs usually during the first pregnancy in the second trimester and is observed in 5-10% of women. You should be aware that this may occur during the next pregnancy.

The occurrence of ICI: causes

The muscle ring in the isthmus is weakened when integrity is violated and muscle tone decreases. The causes of pathological insufficiency may be associated with the anatomical structure of the uterus or functional disorders.

Anatomical isthmic-cervical insufficiency is associated with a violation of the walls of the uterus. These disorders can occur during childbirth when using forceps, with ruptures, breech presentation fetus, congenital pathology development . The weakening of the cervix can be affected by abortion and the curettage carried out for this.

In order for the cervix to open, stimulation is performed during the abortion procedure. Even in the early stages, the woman's body is not ready for this. Therefore, a special dilator is inserted into the cervical canal, which can lead to small and imperceptible tears on the mucosa. In the future, the cells of the cervix tend to collapse.

Functional impairments include:

Hyperandrogenism
Increased androgen content
congenital tissue dysplasia
Multiple pregnancy
Sexual deficiency

This type functional insufficiency often develops early. The pancreas in the fetus begins to function from 12 weeks. She begins to produce androgens. If their number in a pregnant woman is increased, then this will affect the muscles of the neck.

When multiple pregnancy or polyhydramnios on the cervix, the load doubles. This factor can also cause the development of isthmic-cervical insufficiency.

The risk of developing ICI increases with cervical rupture, underdevelopment of the genital organs. Such a pathological condition occurs at a period of 16-27 weeks. In rare cases, a weakening of the cervix occurs up to 12 weeks.

If the cervix is shortened and has a length of 20-25 mm for a period of 20-30 weeks, then there is a risk of premature birth.

Women at risk, who are characterized by habitual miscarriage, should be constantly examined. In the early stages, the state of the cervix is monitored if there are suspicions of anatomical insufficiency. At the 16th week of pregnancy, monitoring is carried out for functional insufficiency.

The gynecologist examines the neck in the mirrors, conducts a vaginal examination. To assess the condition of the internal pharynx, as well as to determine the length of the neck, an ultrasound examination is performed.

Symptoms of ICI

Among the many symptoms that indicate a threat of termination of pregnancy, the most alarming for a woman is cramping pain in the lower abdomen.
With isthmic-cervical insufficiency, a woman may not feel certain signs and symptoms. The cervix opens gradually, slowly and does not cause discomfort to the pregnant woman.

During the examination of the vagina, as well as the outer part of the cervix using a gynecological mirror, it is possible to identify the following signs ICN:

The neck is shortened and softened
The external os is closed
Closure of the cervical canal (complete or incomplete)
Slight dilatation of the neck

A pregnant woman in the early stages with ICI may be disturbed by discharge with blood and mucus, pulling pain in the abdomen, a feeling of fullness in the vagina.

What is the danger of CCI during pregnancy

Possibility of effusion when opening the cervix amniotic fluid Anytime. Various bacteria are present in the woman's vagina. In addition to bacteria, infections may be present, so the risk of infection of the fetus increases, since there is no protective barrier. One of the common complications of CCI is interruption.

After the opening of the cervix, fetal descent may occur.

Isthmic-cervical insufficiency can lead to miscarriage, childbirth ahead of time, miscarriage. In addition, against the background of cervical insufficiency, the development of chorioamnionitis is possible.

The onset of labor is evidenced by the outflow of amniotic fluid. most common cause miscarriages and premature births is isthmic-cervical insufficiency.

The prognosis is unfavorable if the pregnant woman has a short term and a large opening of the cervix.

How is childbirth with ICI

In most cases, childbirth with isthmic-cervical insufficiency passes quickly. It is necessary to take into account the individual characteristics of the woman, as well as the course of pregnancy.

Bringing the baby to term will help timely therapy. The woman is admitted to the hospital in advance to monitor her condition.
childbirth, and postpartum period, after surgery or the introduction of a pessary for CCI are no different from childbirth in women without cervical insufficiency.

When diagnosing isthmic-cervical insufficiency of the anatomical type, it is possible to make a decision on delivery by caesarean section. This method will help to avoid injuries of the cervix when.

ICI is serious complication during pregnancy, so a woman must comply with all medical recommendations, comply with the rules and regulations. Then there is a high probability that childbirth will begin on time.

Methods for diagnosing ICI

It is very difficult to diagnose ICI in many cases due to the asymptomatic course of the pathology. Therefore, it is important for a pregnant woman to visit a doctor regularly for a vaginal examination.

If a woman has previously experienced such a pathological condition, she will carefully monitor the course of pregnancy.

On examination, the doctor pays attention to the softening of the neck, its shortening or opening. If the neck at a period of 24-28 weeks has a length of 35-45 mm, and at a later date after 28 weeks 30-35 mm, then no pathological process occurs.

It is possible to determine the pathological condition in the early stages with an ultrasound examination. If the diameter and length of the neck is not correct, then this may indicate a threat of interruption.

If the cervix outside of pregnancy is expanded by 1-2 cm, then during the period of gestation, the insufficiency will be confirmed.

In addition to ultrasound diagnostics, X-ray hysterosalpiningography is used to confirm the diagnosis. This method is based on the introduction of contrast agents into the uterine cavity.

Treatment of cervical insufficiency

After confirming the diagnosis of isthmic-cervical insufficiency, the doctor chooses conservative or surgical treatment.

When diagnosing functional isthmic-cervical insufficiency, which occurs due to hormonal disruptions in the body, hormone therapy is prescribed. This therapy promotes recovery normal level hormones. A course of treatment hormonal drugs is 7-14 days.

In case of deterioration of the situation, another method of treatment is chosen - the use of a pessary.

Conservative treatment of ICI involves the forcible narrowing of the internal os with the help of a pessary. This plate is oval or round shape made of plastic or silicone. A pessary is introduced as a preventive measure to avoid premature birth.

A pessary is used for the following conditions:

Incomplete closing of the pharynx
Suture failure during ICI correction
multiple

The pessary performs a corrective function. With its help, the load on the receptors of the uterus is reduced, the cervical canal is fixed, and the cervical opening is completely closed.

The pessary can be installed at any time. When installing the ring, anesthesia is not required. Since the ring is foreign body, it may lead to violation normal microflora vagina. To avoid this, swabs are regularly taken from a pregnant woman and, if necessary, the vagina is sanitized. The pessary can move during wear, so when consulting a doctor, it is necessary to periodically check the position of the ring.

Remove the pessary at 38 weeks, as well as at the beginning of labor.

Surgical correction of the cervix in ICI

At non-pregnant women when diagnosing isthmic-cervical insufficiency, surgical treatment is performed, which involves plastic surgery of the cervix.

To prevent gaping of the pharynx, stitches are applied to pregnant women. The result is a narrowing of the internal pharynx. The suture is applied with non-absorbable threads. Usually silk is used.

The surgical operation is carried out taking into account individual features women. In most cases, suturing is carried out up to 17 weeks. Surgery may be performed later if indicated. This operation held in stationary conditions under the influence of short-term anesthesia. At the same time, anesthesia is carefully selected so as not to harm the child.

The main indications for surgical correction:

Early and premature birth
Progressive form of insufficiency
Signs of CCI after vaginal examination

A few days before the surgical manipulation, the gynecologist takes a smear on the flora. Before the start of the operation, the vagina is sanitized. If, with sutures, a pregnant woman has uterine tone, then drugs are prescribed to reduce it: Magnesia, Ginipral, Papaverine, etc.

After the correction that eliminates the inferiority of the internal os without protrusion into the cervix, women can get up and walk immediately. In order to prevent 3 days, suppositories Papaverine, No-shu and electrophoresis are prescribed. A pregnant woman with bladder prolapse after suturing should adhere to bed rest for 10 days.

The sutures are removed for a period of 38 weeks, with leakage of amniotic fluid, the presence of bloody discharge, at the beginning of labor. The sutures may be removed ahead of time due to complications. In this case, correction and treatment of the complications that have appeared are carried out.

After surgical correction, tissue eruption with a thread is possible. This can occur with a high contractile activity of the uterus with sutures, with an incorrectly performed operation, when the neck is strongly constricted with sutures and in the presence of inflammatory processes.

Contraindications to surgery and the introduction of a pessary

With isthmic-cervical insufficiency, suturing the neck is contraindicated in the following cases:

fetal CM
Increased tone of the uterus
Inflammatory processes in the pelvic organs

If there are signs, surgical correction on the neck is not performed.

It is forbidden to introduce a pessary with recurrent spotting in the second and third trimesters of pregnancy. The ring is not inserted for inflammatory diseases of the cervix and vagina.

An obstetric pessary is not used if there are signs of a missed pregnancy and prolapse of the fetal bladder.

Prevention of cervical insufficiency

The effectiveness of treatment depends on the form of isthmic-cervical insufficiency, gestational age, the presence of concomitant diseases.

A woman during pregnancy must follow all the recommendations of a gynecologist to maintain pregnancy. Prevention of isthmic-cervical insufficiency during pregnancy involves compliance with the following rules:

Limit physical activity
Avoid stressful situations and emotional upheavals
Visit the gynecologist regularly
Take medications prescribed by your doctor
Avoid sexual intercourse during pregnancy
Avoid unwanted pregnancy and abortion
Timely treatment of hormonal dysfunction

It is important to identify and treat before pregnancy gynecological diseases so that you do not have to take drugs to eliminate them during pregnancy. A woman must be registered in a antenatal clinic in a timely manner before the 12-week period.

Pregnant women at risk should be regularly examined by a gynecologist.

While watching the video, you can learn about pathologies during pregnancy.

Correct and timely treatment cervical insufficiency reduces the risk of miscarriage by 2 times. Therefore, in order to maintain pregnancy and avoid premature pregnancy, all the recommendations of the gynecologist should be followed.

Isthmic-cervical insufficiency - pathology of the neck, in which it loses its correct form and can not cope with the load caused by the growth of the fetus and the amount of amniotic fluid. This is the most common cause of miscarriages in the second and third trimester of pregnancy. The disease occurs in 9% of pregnant women.

A symptom of the disease is the opening of the cervix, which is not accompanied by any discharge or pain. That is why women often find out about the presence of such a pathology only after the first miscarriage. In some cases, pregnant women complain of frequent urination, copious discharge and a feeling of heaviness in the lower abdomen. But these symptoms are very rarely alarming, as they appear in many expectant mothers.

numerous and scrapings;
trauma of the cervix during childbirth;
dysfunction of the ovaries;
the formation of scar tissue as a result of the treatment of polyps or erosion by cauterization or partial excision. As a result, the uterus loses its ability to contract and stretch normally;
congenital anatomical features uterus.

Diagnosis of isthmic-cervical insufficiency

The disease can be diagnosed with normal gynecological examination using a mirror. In many women's consultations the doctor examines a pregnant woman only 2-3 times during her stay on the register, so if you are worried about your health, take the initiative to have an examination every month of pregnancy. With ICI, the uterus is shorter than the prescribed 4 cm, with a pronounced form of the disease, the gynecologist can examine the hanging membrane of the fetal bladder. On initial stages the accuracy of the diagnosis may be in doubt, so the doctor will give the patient a referral for an ultrasound scan (price - from 500 rubles), which will help determine exact dimensions uterus and recognize pathology.

Conservative treatment of isthmic-cervical insufficiency

If isthmic-cervical insufficiency has developed against the background of malfunctioning of the ovaries, a woman is indicated for several weeks (cost 1000-2000 rubles). After this period, the patient is examined by a doctor and, in the absence of visible improvements, prescribes repeated course. If there is no positive dynamics even after a double dose of hormones, other treatment options should be considered.

In case of pathology of the uterus of mild and moderate severity, a woman is prescribed conservative treatment with the help of a pessary - a special design that has the shape of a closing ring and is put on the cervix to restore its anatomical shape. This method of treatment can be carried out at home for any period up to 36 weeks. Here you can find out everything about . The cost of installing this medical device- from 1000 rubles. The final price will depend on which institution you apply to - public or private.

During the period of treatment, a woman should avoid stressful situations and nervous strains, not overwork, refrain from and playing sports. With complex treatment and corresponding psychological mood pregnancy can be saved in 65% of cases.

Surgical treatment of isthmic-cervical insufficiency

If the length of the cervix is only 2 cm, then the only way eliminate the pathology - surgery (cost from 1500 rubles). The procedure involves the suturing of a special material to prevent further opening of the uterus. It is recommended to perform the operation at 13-17 weeks of pregnancy; in the later stages, surgical treatment is less effective. Before surgery, a woman must be prescribed an ultrasound scan to assess the location of the placenta and the intrauterine state of the fetus.

The procedure is carried out under the maximum safety for the pregnant woman and the fetus. local anesthesia in a hospital setting. After suturing for several weeks, a woman is recommended to take drugs to reduce the tone of the uterus. The pregnant woman stays in the hospital for at least 5 days. The doctor examines the patient daily and treats the cervix with antiseptics. The stitches are removed shortly before childbirth - on. If labor activity begins when the stitches are still in place, be sure to warn the doctor about this so that he can remove them and prevent damage to the uterus.

The next pregnancy with isthmic-cervical insufficiency can be planned no earlier than in two years. You should first contact a gynecologist and go through all the prescribed medical examinations.

At serious violations anatomy of the cervix, it can be restored only with the help of plastic surgery, the cost of which starts from 5000 rubles. You can plan a pregnancy only a year after the intervention.

Contraindications for surgical treatment:

severe forms of diseases of the liver, kidneys, cardiovascular system;
diseases accompanied by frequent bleeding;
a history of two or more pregnancies that ended in miscarriages in the second and third trimester;
congenital incompatible with life;
placenta previa.

ICN treatment reviews

Julia, 2 3 years old, 2015

At 19 weeks, she did an ultrasound, the cervix was 21-23 mm, the doctor looked, she said it was not necessary to put it yet, she drank ginipral for 2 weeks, inserted utrozhestan, she looked and says the cervix is not very good, in general, they put me a pessary at 21 weeks, at 26 weeks she did ultrasound, the cervix was 31mm, at 30 weeks it was already 40mm, at 38 weeks the pessary was removed, of course, the discharge was terrible with it, it was necessary to sonate more often, in general, it was removed, and I had 3 fingers dilated, the next day the bubble was opened and I through I gave birth for an hour, in my opinion this pessary made it possible for me to bear the child, kept me.

Anna, 27 years old, 2014

I was hemmed at 13 weeks, the neck was 30mm. I drank utrozhestan, vitamins, sedatives! after hemming, she lay for four days without getting out of bed at all! Then another week in the hospital. Well, in general, almost the entire pregnancy lay on the conservation. in the most dangerous periods when miscarriages happened!

Julia, 20 years old, 2012

I also had ICI at 20 weeks and the opening of the cheek by ultrasound. Until the end of pregnancy, she drank Dufaston, General. If it was necessary to go somewhere, then Riabal pricked. Has been in storage until maternity leave and were discharged home. Mostly at home. I went out only where for 1 hour to breathe air. At 35.5 weeks, contractions began, proceserized - boy 2340.

Natalia, 22 years old, 2015

ICI cost me a baby lost at 22 weeks. My donkey doctor, did not notice dilation and lack of progesterone. Yes, and looked at me in the chair only once when registering.

Complications of isthmic-cervical insufficiency

Very often due to violation normal structure uterus, it becomes infected with harmful microbes. Therefore, when making a diagnosis of isthmic-cervical insufficiency, a woman must pass on the microflora and bacteriological culture. Untreated diseases threaten infection of the fetus.

Isthmic-cervical insufficiency is not a sentence. Subject to all the recommendations of the doctor and the treatment regimen, there are considerable chances to keep the pregnancy and give birth to a healthy full-fledged child.

ICI during pregnancy

Isthmic-cervical insufficiency during pregnancy (ICN) is a non-physiological process characterized by painless opening of the cervix and its isthmus in response to an increasing load (an increase in the volume of amniotic fluid and fetal weight). If the condition is not corrected therapeutically or surgically, then this is fraught with late miscarriages (before) or premature birth (after 21 weeks).

The incidence of CCI
Indirect causes of insufficiency of isthmic- cervical canal
Symptoms of CCI during pregnancy
The mechanism of development of isthmic-cervical insufficiency of the cervix
ICI correction methods
The imposition of circular sutures in isthmic-cervical insufficiency
Unloading pessary for isthmic-cervical insufficiency
How is a pessary selected?
Management of pregnancy in ICI
How many weeks is the pessary removed?

The incidence of CCI

In the structure of late miscarriages and premature childbirth ICI occupies a significant role. Isthmic-cervical insufficiency is common according to data from various sources from 1 to 13% of pregnant women. In women who have had a preterm birth in the past, the frequency increases to 30-42%. If previous pregnancy ended on the term -, then the next one in every fourth case will not last longer without correction and treatment of the causes.

CCI is classified by origin:

Congenital. Associated with malformations -. Requires careful diagnosis and surgical treatment at the stage of conception planning.
Acquired
Post-traumatic
Functional.

Often, cervical insufficiency is combined with the threat of interruption and a pronounced tone of the uterus.

Indirect causes of isthmic-cervical insufficiency

Predisposing factors for insufficiency of the cervical part of the birth canal are cicatricial changes and defects that form after injuries in previous births or after surgical interventions on the cervix.

Causes of isthmic-cervical insufficiency are:

the birth of a large fetus;
the birth of a fetus with a breech presentation;
the imposition of obstetric forceps during childbirth;
abortions;
diagnostic curettage;
neck surgery;
connective tissue dysplasia;
genital infantilism;

The identified cause must be treated surgically at the stage of pregnancy planning.

The functional cause of ICI is a violation of the hormonal balance necessary for right flow pregnancy. Shift hormonal balance happens as a result:

Hyperandrogenism is an excess of a group of male sex hormones. Fetal androgens are involved in the mechanism. At -27 weeks, he synthesizes male sex hormones, which, together with maternal androgens (they are normally produced), lead to structural transformations of the cervix due to its softening.
Progesterone (ovarian) insufficiency. A hormone that prevents miscarriage.
Pregnancy that occurred after induction (stimulation) of ovulation by gonadotropins.

Correction of isthmic-cervical insufficiency of a functional nature makes it possible to successfully maintain pregnancy in a therapeutic way.

Isthmic-cervical insufficiency during pregnancy and symptoms

It is precisely because of the lack severe symptoms isthmic-cervical insufficiency is often diagnosed after the fact - after a miscarriage or premature termination of pregnancy. The opening of the cervical canal proceeds almost painlessly or with mild pain.

The only subjective symptom of ICI is an increase in volume and a change in the consistency of secretions. In this case, it is necessary to exclude leakage of amniotic fluid. For this purpose, a smear for arborization is used, an amniotest, which can give false results. More reliable is the Amnishur test, which allows you to determine the proteins of amniotic fluid. Violation of the integrity of the membranes and leakage of water during pregnancy is dangerous for the development of infection of the fetus.

Signs of isthmic-cervical insufficiency are seen with vaginal examination carried out during registration in the 1st trimester of pregnancy. The study determines:

length, consistency of the cervix, location;
the state of the cervical canal (passes a finger or its tip, normal - the walls are tightly closed);
the location of the presenting part of the fetus (at later stages of pregnancy).

The gold standard for diagnosing CI is transvaginal echography (ultrasound). In addition to changes in the length of the neck on ultrasound with isthmic-cervical insufficiency, the shape of the internal os is determined. The most unfavorable prognostic sign of ICI are V- and Y-shaped forms.

How does cervical insufficiency develop?

The trigger mechanism for the development of ICI during pregnancy is an increase in the load on the area of \u200b\u200bthe internal pharynx - the muscular sphincter, which, under the influence of pressure, becomes insolvent and begins to open slightly. The next stage is the prolapse (sagging) of the fetal bladder into the expanding cervical canal.

Methods for correcting insufficiency of the isthmic-cervical canal

There are two main types of correction of isthmic-cervical insufficiency:

conservative method;
surgical.

Suturing for isthmic-cervical insufficiency of CCI

Surgical ICI correction occurs by imposing a circular seam. For this purpose, mersilene tape is used - a flat thread (this form reduces the risk of seam cutting) with two needles at the ends.

Contraindications to suturing in isthmic-cervical insufficiency:

suspicion of leakage of amniotic fluid;
malformations of the fetus incompatible with life;
pronounced tone;
and bleeding;
developed chorioamnionitis (with isthmic-cervical insufficiency, there are high risks of infection of the membranes, fetus and uterus);
suspicion of insolvency of the scar after caesarean section;
extragenital pathology, in which prolongation of pregnancy is impractical.

What are the disadvantages of surgical sutures for CCI?

The disadvantages include:

invasiveness of the method;
possible complications of anesthesia (spinal anesthesia);
the possibility of damage to the fetal bladder and induction of labor;
the risk of additional trauma to the cervix when cutting the sutures at the beginning of labor.

Miscarriage is not only an obstetric problem, but also a family and personal drama, the deepest inner experiences.

Of all the cases of miscarriage, enough a large percentage belongs to a state called isthmic-cervical insufficiency (ICN) or insufficiency of the cervix.

What is cervical insufficiency?

The word "isthmus", from which this term comes, refers to a small area between the cervix and its body, the narrowest place through which the uterine cavity communicates with the cervical canal and external environment. The isthmus and cervix during pregnancy have, among others, one more role - the obturator function. It is this part of the uterus that is responsible for holding the fetus.

Normally, the cervix, as doctors say, matures only by the birth itself: its consistency changes, and the lumen of the canal increases to such a size that it is possible to miss the child being born.

Insufficiency of the cervix is a violation of its "closing" function, which is directly related to the shortening of the cervix. Wherein inner part cervical canal - internal os uterus - expands, amniotic sac ruptures and the pregnancy is terminated.

Causes isthmic-cervical insufficiency

ICI occurs as a result of an absolute decrease in the length of the cervix. The reasons leading to the shortening of the neck can be divided into two large groups:

1. Congenital CI- due to any gross violations of the structure of the uterus, present in a woman from birth. These include genital infantilism or malformations of the uterus. Congenital insufficiency of the cervix is usually associated with other gynecological problems, also due to anatomical anomalies. Such women often have problems with conception, there are menstrual irregularities.

2. Acquired ICN occurs much more often, since it is always secondary, and there are a lot of reasons leading to the formation of cervical insufficiency during life. These include, in particular:

traumatic medical and diagnostic manipulation, incl. those in which an operation was performed on the cervix with the removal of its part, as well as after abortion, hysteroscopy, conization of the cervix;
organic changes cervix- situations where any previous disease of the cervix left its mark and led to a gross violation of the anatomy in this part of the uterus. Organic changes in this situation are always associated with trauma. Causes:
- Traumatic childbirth, accompanied by a rupture of the neck and subsequent fusion with the formation of cicatricial deformities.
- Functional inferiority of the cervix - is usually a consequence hormonal disorders. It is observed with insufficiency of ovarian function or with the so-called. hyperandrogenism - a condition when the content of male sex hormones is increased in a woman's body. It also occurs at systemic diseases connective tissue (systemic lupus erythematosus, rheumatoid arthritis and etc.)

Complications and danger isthmic-cervical insufficiency

It should be said that the shortening of the cervix itself is asymptomatic, and this is associated with certain difficulties in the diagnosis of CI, in particular, the late negotiability of women.

In the event of pregnancy against the background of ICI, the main danger is early termination of pregnancy in the II and III trimester.

Since the body of a woman at such a time is not yet ready for childbirth, they are completely unphysiological and are accompanied by a mass of complications. Thus, the complications of CI include:

Premature spontaneous abortion;
bleeding;
Rupture of the fetal membrane (amnion);
Infection of the fetus with the development of sepsis, chorioamnionitis.

Symptoms, signs, diagnosis of cervical insufficiency

Despite the fact that ICI is one of the main causes of miscarriage, pregnancy itself is not accompanied by any symptoms characteristic of a threatened miscarriage. Only with a targeted study can it be found that the cervix is shorter than it should be in the norm.

It is on the identification of this sign - shortening of the cervix - that the entire diagnostic search algorithm is oriented.

An important point that may prompt the doctor to think about ICI is the presence in the anamnesis of data on previous spontaneous miscarriages and premature births that occurred in the II or III trimesters of pregnancy.

Regardless of the number of pregnancies, the diagnosis of ICI is helped by the following methods of examining the patient:

vaginal finger examination: allows you to evaluate the length of the cervix, the state of the cervical canal and its patency, as well as detect cicatricial changes in the cervix.
Examination of the cervix in mirrors: allows you to see an enlarged, gaping external os, from which a fetal bladder can protrude.
ultrasound: is the main method early diagnosis and constant monitoring of the degree of ICI. In this case, you can see the entire cervix, assess its condition, as well as the condition of the cervical canal. Signs of ICI are a decrease in the length of the cervix to 25 mm or less, as well as the opening of the cervical (cervical) canal by more than 9 mm.

Treatment isthmic-cervical insufficiency

It should be emphasized that the detection of a shortening of the cervix or the presence of coarse scars in it does not in itself always indicate that such a cervix will not hold a growing fetus.

In most cases, the diagnosis of CCI requires not only the detection of deviations from the anatomical norm, but also other signs.

Only surgery can have an active effect on the ICI, the purpose of which is to further strengthen the lower segment of the uterus and prevent its excessive opening during pregnancy. For this purpose, two types of operations are usually used:

Sewing of the cervix with a purse-string (tightening) circular suture (MacDonald operation or V.M. Sidelnikova operation);
The imposition of several separate sutures in the shape of the letter "P" along the perimeter of the cervix (operation by A.I. Lyubimova and N.M. Mamedalieva);

Having sewn up the cervix with non-absorbable suture material, the woman is prescribed a short course of antibiotics with minimal effect on the fetus (usually penicillins) or topical antiseptics.

In addition, to reduce the activity of the uterus, drugs are prescribed that relax the uterine muscles and thus reduce the load on the operation area - antispasmodics (drotaverine), adrenomimetics (hexoprenaline), calcium antagonists (verapamil).

Within a week after the operation, the woman is observed in the hospital, after which she is discharged. The stitches on the neck are removed, again, in the hospital just before the birth itself - at 37-38 weeks. In the interval between the operation and the removal of sutures, the pregnant woman is under outpatient observation and is examined by an obstetrician of the antenatal clinic every two weeks.

Such operations are not performed for all pregnant women with a shortened cervix. The indication for surgical intervention is a combination of anamnestic and clinical signs, namely:

The presence of a pregnant woman in the history of spontaneous miscarriages or premature births that have already taken place;
The presence of signs of CI detected clinically (vaginal examination) and instrumentally (transvaginal ultrasound examination).

Unfortunately there are general contraindications to conduct operations of this type - states where the operation itself can cause more harm, its implementation is not feasible or prolongation of pregnancy is impractical. These include:

Bleeding that occurs during pregnancy;
Inability to reduce increased tone uterus with medication;
infectious inflammatory processes pelvic organs in the acute stage;
Congenital malformations of the fetus;
Any serious illnesses in which the prolongation of pregnancy may threaten the life of the mother - for example, unresponsive to therapy gestosis, progression of heart or respiratory failure, kidney disease, mental illness and etc.

Complications of the operation can be typical - bleeding, infection of the fetus with the development of chorioamnionitis, as well as specific ones, which include cutting through the tissues of the growing uterus with threads suture material, the formation of fistulas and bedsores at the site of suturing. If, for some reason, the sutures are not removed on time, before the onset of labor, then a circular rupture and even complete separation of the cervix may even occur.

It should be noted that surgical treatment of CI is effective in 85-95% of cases, which is a very good indicator.

Of the minimally invasive methods of treating CI, it should be mentioned use of a pessary a special plastic or silicone ring that is worn on the cervix. The obstetric pessary is also called the Mayer ring - after the obstetrician who suggested its use. Its efficiency is also quite high. A pessary can be used if there are some contraindications to surgery.

Outside of pregnancy, women who are diagnosed with CI can in some cases undergo a cervical plastic surgery - for example, surgery Yeltsova-Strelkova in the presence of cervical-vaginal fistula or when restoring a damaged cervical canal.

The course of pregnancy and childbirth with cervical insufficiency

Outside the manifestations of preterm labor in women with ICI pregnancy proceeds normally and has no specific signs.

Very rarely, a woman may complain of a feeling of fullness, pressure, discomfort in the lower abdomen. If this happens and a spontaneous miscarriage begins, then the complications already mentioned above arise, the most dangerous of which are bleeding and ascending infection.

To prolong pregnancy, it is very important to maintain medical and protective regimen and exercise regular medical supervision.

ICI has a peculiarity in multiple pregnancy: it progresses very quickly and most often begins after the 22nd week of pregnancy. And if in the case of twins, operations that strengthen the cervix are indicated, then for pregnant women with triplets this issue has not been finally resolved: the growth of triplets occurs so quickly that the sutures are unable to restrain the increasing load and cut through. The problem of ICI in multiple pregnancies is now very common, since it is precisely such a pregnancy that often accompanies in vitro fertilization.

If a woman outside of pregnancy underwent cervical plastic surgery for CCI, then the only safe method delivery in this case is C-section.