Carrying out an operation to suture the cervix. Suturing the cervix is ​​the path to a successful pregnancy

Pregnancy is an important and responsible period in the life of every woman. Unfortunately, health problems are not uncommon at this time. And in some cases, the doctor recommends a special procedure to the patient, during which a suture is placed. Stitches are needed on the cervix during pregnancy to prevent miscarriage or premature birth.

On the other hand, surgery during pregnancy frightens women. So in what cases is such a procedure prescribed? What risks does it involve? What is the surgical procedure and how is the rehabilitation period? The answers to these questions are of interest to many patients.

Suturing the cervix during pregnancy: why is it necessary?

The uterus is an important organ of the reproductive system. This is where implantation of the fertilized egg and further development of the embryo occurs. Normally, the cervix begins to dilate slowly starting at the 36th week. But in some patients the discovery occurs in the early stages.

This is fraught with extremely dangerous consequences for the child, because the growing organism may not yet be viable. Miscarriage or premature birth are consequences that an expectant mother may face. It is in such situations that doctors prescribe suturing the cervix during pregnancy - such a procedure can save the child’s life.

Main indications for the procedure

Of course, there are situations when cervical stitches are simply necessary. Indications for the procedure are as follows:

• Isthmic-cervical insufficiency is a pathology that is accompanied by expansion or shortening. A similar phenomenon develops with anatomical defects of the cervix, which in turn can be associated with mechanical damage, previous inflammatory diseases, cancer, etc.
• Hormonal imbalances, because it is hormones that control the condition of the walls of the reproductive organ. A change in the amount of certain hormones in the blood can cause relaxation or contraction of the muscles of the uterus, and early opening of the cervix.
• If the patient’s history includes information about previous miscarriages or premature births, then the doctor will probably closely monitor the patient’s health and, if necessary, prescribe surgical intervention.

A suture on the cervix during pregnancy can ensure the normal development of the child. However, only an experienced obstetrician-gynecologist is able to decide on the procedure.

What preparation does suturing require?

Applying a suture to the cervix during pregnancy is not a very complicated procedure. However, the doctor can decide to perform surgery only after passing all the necessary tests and tests.

Starting from the 12th week of pregnancy, women are sent for an ultrasound examination, during which a specialist can determine the early dilatation of the uterus. An ultrasound may be repeated to confirm the diagnosis. Naturally, as before any other operation, it is necessary to take blood and urine tests, check the level of hormones in the blood of a pregnant woman and conduct other tests. Immediately the day before the operation, the vagina is sanitized.

Features of surgery

Naturally, patients are interested in questions about how exactly the surgical intervention occurs. In fact, this is not such a complicated procedure, and it lasts no more than 15-20 minutes. Suturing is carried out under general anesthesia. To strengthen the uterus, strong nylon threads are usually used.

The doctor may place a suture on the outer or inner edges of the pharynx. The tissue is usually accessed through the vagina, but in some cases a laparoscopic procedure (through small punctures in the abdominal wall) is required. The number of stitches depends on how far the cervix has dilated.

When are stitches removed?

Already placed sutures on the cervix during pregnancy help preserve the fetus inside the womb. As a rule, they are removed at 37 weeks. Naturally, before this, the woman undergoes an examination and an ultrasound examination, during which it is possible to find out whether the child is developed enough to be born.

Removal of suture material is carried out without anesthesia - this procedure may not be very pleasant, but it is painless and quick. In most cases, birth occurs on the same day. But even if there are no contractions, the woman should be in a hospital setting.

It is worth saying that in some (rare) cases, a suture on the cervix during pregnancy, unfortunately, cannot prevent early labor. Then the stitches are removed as an emergency. If the procedure is not carried out on time, the suture threads can severely damage the pharynx, complicate childbirth and create problems in the future (if the woman wants another child).

Postoperative period: rules and precautions

Sutures on the cervix during pregnancy provide the child with normal intrauterine development. However, the success of the procedure largely depends on how the rehabilitation period goes. The woman spends the first 3-7 days after surgery in a hospital setting, under the constant supervision of doctors. She is prescribed strict intake of antibacterial agents (to prevent inflammation) and antispasmodics (to prevent contraction of the uterine walls). In addition, the seams are regularly washed with antiseptic solutions.

In the first few days, patients feel mild pain in the lower abdomen. Vaginal discharge may appear in the form of ichor, mixed with blood. Such phenomena are considered normal and go away on their own. Gradually the woman returns to her usual way of life.

There are some requirements that should be followed until the end of pregnancy. In particular, the expectant mother should not lift weights, engage in physical labor, or overexert herself (physically or emotionally). Sexual life is also contraindicated. Rest and healthy sleep are important for women and children. Proper nutrition (will help prevent constipation) and walks in the fresh air will have a positive effect on your health.

Suture on the cervix during pregnancy: complications

Like any surgical procedure, suturing involves some risks. The procedure may cause some complications, in particular inflammation. Such a pathology can have different causes - sometimes pathogenic microorganisms penetrate the tissue during the procedure, sometimes even during rehabilitation. In addition, it is possible to develop an allergic inflammatory reaction when tissue comes into contact with suture material. These complications are usually accompanied by the appearance of uncharacteristic vaginal discharge, pain in the lower abdomen, and increased body temperature.

The cervix may become hyperactive after suturing during pregnancy. Due to hypertension, women feel a tugging in the lower abdomen. As a rule, the patient’s condition can be returned to normal with the help of special medications and bed rest.

We should not forget that premature dilatation of the uterus is a consequence, and not an independent problem. It is necessary to conduct a thorough diagnosis, find out what exactly caused the pathology, and eliminate the primary cause. For example, in case of hormonal disorders, the patient is prescribed to take special hormonal medications. Chronic inflammation also requires specific therapy.

Contraindications to the procedure

It is worth noting that this procedure cannot be carried out in every case. A suture on the cervix during pregnancy is contraindicated in the following cases:

• The presence of a sluggish inflammatory process in the organs of the reproductive system.
• Increased excitability of the uterus (this refers to cases when it cannot be eliminated with medication).
• Bleeding.
• Blood clotting disorders, as massive blood loss is possible.
• Severe chronic diseases, including damage to the kidneys, heart or liver.
• Frozen pregnancy, death of a child in the womb.
• The presence of certain anomalies in the process of child development (if this is confirmed through diagnostic procedures and tests).
• Suturing has a time limit - the intervention is not performed after the 25th week of pregnancy.

It is worth saying that if for some reason the surgical procedure is impossible (for example, if the problem was diagnosed too late), then a special pessary made of durable plastic is placed on the uterus. It not only keeps the cervix closed, but also partially relieves the load on the uterine walls. In addition, the patient is recommended to undergo strict bed rest.

There are pathological abnormalities that cause the risk of uncontrolled abortion. Suturing the cervix makes it possible to combat spontaneous miscarriages during pregnancy and significantly increases the likelihood of having a normal child.

Currently, several different methods of this operation are known, the main thing is that the surgical procedure should be carried out in a specialized clinic. Suturing the cervix in artisanal conditions is a very life-threatening undertaking. Carrying out such manipulations by specialists has shown high efficiency and safety.

Reasons for surgery

During a normal pregnancy, the cervix should hold the fetus inside and gradually open only before childbirth. In some cases, pathology may occur during pregnancy, when the process of dilation of the cervix begins at 14 weeks, when the unborn baby is not yet viable. This phenomenon causes relaxation of the uterine muscles, called isthmic-cervical insufficiency (ICI).

This disease most often explains the problem of early miscarriages.

ICI is a shortening and softening of the cervix, an increase in the internal os, leading to damage to the amniotic sac and spontaneous miscarriage.

The main reasons leading to pathology: excess male hormones, previous abortions, anomalies during previous births or physiological underdevelopment of the organ. As a result of the changes, the cervix loses its functional locking role, and the lower part of the amniotic sac becomes infected, and the amniotic fluid leaves prematurely.

Features of the surgical operation

Treatment of ICI at certain stages can be carried out with medication and other methods, for example, using an obstetric pessary. However, the most effective method, with a high probability of ensuring a positive result, is considered to be suturing the cervix. At its core, suturing the cervix (cervical cerclage) is a fairly simple surgical procedure if it is performed in a specialized institution.

The manipulation consists of surgeons, using a needle and thread, suturing the cervix through the vagina, using one of several known techniques, taking into account the individual characteristics of the body. Only in exceptional circumstances are sutures on the cervix made laparoscopically (through an incision in the abdominal tissue).

Any technique has general rules: the operation is based on individual indications for surgery during the period 14-20 weeks of pregnancy; in this case, the most common period is 14-17 weeks, and after 27 weeks, intervention is not performed due to the increased size of the fetus, which causes a risk of complications. Sutures are placed under general anesthesia and removed at 37 weeks of pregnancy. The operation is usually performed after preliminary preparation, but can be performed urgently if there is a high risk of miscarriage.

Methods of performing the operation

Currently, several methods have been developed for performing a surgical operation that allows suturing the pathological change. Fundamentally, there are 2 methods of influence: suturing the external pharynx and narrowing the internal pharynx. Of the first option, the Czendi method is used, which consists of connecting the anterior and posterior lips of the cervix by stitching with silk or kengut threads. This method ensures a closed space in the uterine cavity, which creates the risk of hidden infection.

Methods of suturing in the area of ​​the internal pharynx include the following:

1. Palmer method: tracheolystic mycoplasty - dissection of the vaginal wall, displacement of the bladder, excision of an oval flap in the isthmus zone and sutures made of chrome catgut without damaging the cervical canal.
2. Lasch method: excision of the area from the external pharynx to the isthmus, followed by suturing.
3. Shirodkar's method: placing a circular nylon suture on the cervix in the internal os after cutting the vaginal wall and raising the bladder.
4. MacDonald's method: applying a purse-string suture at the junction of the vaginal mucosa and the cervix with multiple punctures of the vaginal wall without cutting it.
5. Lyubimova's method: the cervix is ​​pulled forward with Museau forceps, a circular silk suture is applied in the area of ​​the entrance of the uterosacral ligaments, with which a copper wire with a diameter of 0.2 mm in a polyethylene sheath is secured.
6. Method of Lyubimova and Mamedalieva: U-shaped seam in the development of Lyubimova’s method.

Indications and contraindications for suturing

Surgical intervention is indicated for severe ICI, which is assessed using a scoring system using ultrasound and transvaginal sonography. The following indicators are taken into account when assessing: the length of the cervix in the vaginal area; patency of the uterine canal; location of the cervix (sacral, central, displaced forward); consistency of cervical tissue; location of the nearest fetal area. The severity of ICI is accepted when the neck is shortened to 20 mm or less; expansion of the internal pharynx (cervical canal) more than 9 mm.

The following possible conditions for cervical suturing are recognized:

• gestational age 14-25 weeks;
• integrity of the membranes;
• absence of increased smoothing of the cervix and obvious prolapse of the fetal bladder;
• exclusion of chorioamnionitis and vulvovaginitis.

The following contraindications exist for the operation:

• dangerous somatic diseases that require termination of pregnancy;
• the likelihood of termination of pregnancy;
• noticeable bleeding during pregnancy;
• abnormal excitability of the uterus, not eliminated by drug therapy;
• pathology of fetal development;
• the occurrence of pathogenic microflora in the uterine canal.

Carrying out the operation

Before the operation of suturing the cervix, preparatory measures are carried out for 2-3 days: microbiological studies of the uterine canal and vagina; tocolytic therapy to reduce uterine tone; treatment of the vagina with antibacterial drugs.

The operation itself is performed quickly (15-20 minutes) using one of the described methods under general anesthesia, which is safe for the fetus and the woman in labor.

The methods of McDonald's and Lyubimova are most often used. The following are used as anesthetic and painkillers: atropine sulfate and midozolam (intramuscular); ketamine (intravenous or intramuscular); propofol (intravenously). After suturing, the body’s natural reaction is considered normal: slight nagging pain and slight bleeding, which should disappear completely on its own after 2-3 days.

Postoperative period

The suturing operation usually does not require strict bed rest, and after signs of anesthesia have disappeared, the patient can walk. To eliminate possible consequences, the following preventive measures are taken:

1. Disinfection of the surgical area with hydrogen peroxide or chlorhexidine for 4-5 days.
2. Prescription of antispasmodics: drotaverine for 3 days.
3. Prescription of adrenergic agonists: hexoprenaline and verapamil for 10 days.
4. Antibacterial drugs as needed in case of negative microbiological studies.
5. If there are no complications, the patient is discharged from the hospital 7 days after the operation.

Sutures are removed at 37 weeks of pregnancy. After surgery, patients are not recommended to have sexual intercourse, lift weights, sit for a long time, overwork, or be under stress.

The effectiveness of suturing the cervix while maintaining pregnancy is estimated to be above 90%, which gives a high chance of giving birth to a normally termed baby. To ensure a positive result, you must follow all the doctor’s instructions and be constantly examined by a gynecologist, incl. using ultrasound. It is important to correctly follow a gentle preventive regimen before childbirth.

At week 17, the cervix was sutured (there was a miscarriage in the past at this stage, dynamic shortening of the cervix and opening of the internal os). I re-read everything on the site about ICN and suturing, and about tocolytic therapy. But there remain a number of questions regarding which (due to great experiences) I would very much like to receive an additional answer. (The brains give in to panic when they are worried).

Do I understand correctly that after stitching:

1) there is no particular point in lying down, because according to research this does not affect the situation (except for multiple births)

2) there is no point in any tocolytics, because there are no effective ones anyway (or are there some that are still justified?). Do I need to take any special pills after stitching?

3) is it necessary to inject - take antibiotics immediately after stitching? How many days? (It’s not good for a child, so it worries me a lot, I’ve been injected for 5 days now)

4) is suture rehabilitation necessary? If yes, how often? Only immediately after application for a couple of days or then too?

5) is it true that the tone of the uterus during sutures is not dangerous, because whether it was tone at all was unknown (it is often misdiagnosed on ultrasound) and it is not a constant phenomenon. In addition, in fear, fighting tone is a useless way, since this is what it appears from. It's right? If not, then what about the tone at the sutures? How should we approach this issue? Is he dangerous at all?

6) Do I understand correctly that after suturing, smears and examinations in a chair and ultrasound are recommended every 2 weeks? What exactly is being checked during these procedures? The strokes are still somewhat clear, but the rest is not so good. On smears they look primarily at leukocytes, right?

7) and in light of the question above: what dynamics of the length of the neck and the opening of the internal pharynx should be after suturing (ultrasound)? Should everything lengthen and close? How fast? What if it shortens and opens further? Or is this an unimportant factor? Why then regular ultrasounds?

I beg your pardon for the number of questions, but I know the official answers of traditional gynecologists to them (even many options), but I don’t really trust them, because no one can really explain anything and they prescribe “because”. At the same time, sometimes even I can understand that the logic in the answers is broken and the person most likely does not understand what he is talking about. I got myself into trouble with this.

During pregnancy, the cervix serves as a “gate” that holds the unborn baby inside the mother’s body. In some situations, there is a risk that it will open ahead of time. To prevent this from happening, doctors perform a simple operation on the woman - they tighten the cervix with special sutures.

It may open ahead of schedule for several reasons. Some women (fortunately not many) have cervical tissue that is too weak from birth. As the future baby grows, the load on the tissues increases, and one day they may not be able to cope with it. The cervix may dilate prematurely in women with an irregularly shaped uterus; if the uterus is damaged; and also with certain hormonal disorders (for example, with increased levels of male hormones). Expectant mothers who have already had difficulties during a previous pregnancy, for example, should be especially careful. An examination by an obstetrician-gynecologist and an ultrasound will help a woman identify the problem in advance, make an accurate diagnosis and provide timely treatment. Sometimes this requires several examinations; they are carried out from the 12th to the 25th week of pregnancy.

Problem and solution

What happens when the cervix opens before its due date? In this case, the membranes in which the baby is located will descend along its canal into the vagina and rupture. If the period is still short (up to 22 weeks), the pregnancy will be terminated after that. If the cervix opens “without asking” by the time the baby is old enough (after 28 weeks), the baby will be born ahead of time.

To prevent this problem, doctors “sew up” the cervix with special sutures - a “ring”. And there is another way out - the expectant mother is prescribed bed rest until the end of pregnancy. True, this method can only help if it is too late to apply a suture (after 25 weeks of pregnancy) or if the operation is not worth doing for some reason.

Firmly and firmly

Overlay stitches on the cervix- a simple operation, but it is performed only in the hospital. This method was invented 50 years ago by the Indian doctor Shirodkar. The surgeon sutures the cervix with non-absorbable nylon or mylar thread and then secures the thread with a knot.

Most often, this procedure is carried out at 13-20 weeks of pregnancy. Before the operation begins, the woman is given a painkiller that is safe for the baby, and she falls asleep for a short time.

After the stitch is placed, the expectant mother usually remains in the hospital for several days. During this time, doctors give her a short course of treatment with antibiotics and drugs that relax the uterus. Immediately after surgery, many women feel a slight nagging pain; appear . These symptoms are completely normal and usually go away on their own within a few days.

Stitches from the cervix removed at the 37th week of pregnancy. This operation is painless; it is carried out in a antenatal clinic or in a maternity hospital without pain relief. Even if the baby decides to be born immediately after this, it’s okay. But more often than not, the expectant mother goes home and gives birth, as expected, in about half a month.

Caution won't hurt

As a rule, cervical surgery does not greatly affect the lifestyle of the expectant mother; You only need to take special care of yourself in the first week after the procedure. But, like all pregnant women, the expectant mother should not work hard, drive for a long time and - what is especially important - under no circumstances should she lift heavy objects. In addition, she needs to be examined by a doctor every 2-3 weeks.

To love or not to love?

After application stitches on the cervix Doctors often advise women to refrain from having sex, because uterine contractions during intimacy can cause premature contractions. But even if the doctor finds that there are no obstacles to love, it is worth remembering: despite the suture, in the second trimester of pregnancy the cervix remains open and becomes more vulnerable to microbes. So the expectant mother should ask her partner to get tested for sexually transmitted infections or use a condom.

A serious problem during pregnancy is repeated miscarriages, especially in the later stages, called miscarriage.

The reason for this is often anatomical defects of the cervix associated with its mechanical damage during previous births, abortions, conization due to erosion, dysplasia and cancer. These changes are characterized by shortening or expansion of the internal (cervical) canal of this organ, so-called isthmic-cervical insufficiency occurs. In addition to anatomical defects, the development of this condition is also influenced by a lack of the hormone progesterone.

Further, during pregnancy, the load on the cervix increases due to the fetus and the amniotic sac with amniotic fluid drops lower than it should be, inflammation develops in its wall, amnionitis and subsequent rupture, then fetal death and miscarriage occur. If the gestational age allows, then the child can be saved, but this is often after 26 weeks.

How to avoid

If this problem has already occurred, then you should contact a gynecologist who is involved in pregnancy planning, the condition of the cervix will be assessed, and other possible causes leading to miscarriage will be identified and eliminated. If shortening or post-traumatic dilatation of the cervix is ​​detected, the doctor must decide on methods for correcting these changes. As a rule, isthmic-cervical insufficiency is then determined, and if pregnancy occurs at certain stages, it is recommended to apply a cerclage or circular suture on the cervix around the cervical canal, or rather on top of it.

This intervention is performed as a precaution and its purpose is to prevent the cervix from opening prematurely and causing miscarriage or preterm delivery. If you did not manage to see a doctor in time, and time is lost, then special devices, pessaries, which are inserted into the vagina and relying on the walls of the pelvis support the uterus, thereby reducing the pressure of the fetus, can help.

If a suture is placed on the cervix

So, a suture on the cervix can be placed both as a “planned” procedure and as an “emergency” measure. In the first option, everything is planned before the onset of pregnancy, in the second, after its onset, if during follow-up examinations and ultrasound, changes in the cervix are determined, namely shortening and widening.

As a rule, for the planned placement of a suture on the cervix, a period of 14 weeks is chosen; this is a “just in case” situation when the doctor, assessing the expected risks, tries to prevent a possible complication. Changes in the cervix, shortening and expansion of the internal os, cervical canal, if they occur, usually occur after 18 weeks.

It is during this period that it is important to make a decision in a timely manner and prevent irreversible and tragic consequences. Therefore, the doctor who manages the pregnancy must be experienced; he is also helped by ultrasound diagnostics, the so-called cervicometry. Situations where everything happens as planned are of course preferable, but you need to understand that a gynecologist preparing a woman for pregnancy only identifies the risks and draws up a plan for further management taking them into account. In the antenatal clinic in the future, it can be changed to an “emergency” scenario, that is, a suture will be placed only if specific complications develop. In any case, the fact of miscarriage in the past will make everyone more attentive to the management of this pregnancy.

Suture

This is primarily a surgical procedure and is performed in an operating room using fairly safe intravenous anesthesia. There are a large number of varieties of seams and threads and materials used. The main ones are named after the inventors of the methods; this is the cerclage according to Shrodkar and MacDonald. If possible, it is advisable to use modern suture material, which significantly reduces the risks. The wider the thread, the less it injures the neck; it is better to use a special tape, but this is not always available for economic reasons and doctors are forced to sew more often with ordinary silk.

You will be able to go home a few hours after this, but in Russia this is not customary; more often the patient is hospitalized for up to three days, although from a health point of view this does not have any positive effect, simple reinsurance and the desire of the hospital to receive additional funds from the insurance company. This period can be extended to 5 days or more, especially if the tone of the uterus is increased, this is accompanied by pain in the lower abdomen or spotting.

Restrictions for the remainder of pregnancy

You need to continue to avoid strenuous activities and physical and mental stress as much as possible for the remainder of your pregnancy. There will most likely be some specific restrictions:

Sexual rest until birth. This is done to reduce the risk of infection or bleeding.

You cannot stand for more than 90 minutes at a time.

Do not lift anything heavy more than three kg.

You will have to visit the doctor more often than during a normal pregnancy.

Seam removal

The thread or tape is removed at 37-38 weeks of pregnancy; the suture can be removed from the cervix in a regular office or maternity hospital. Sometimes the stitch needs to be removed earlier. For example, if the amniotic fluid breaks, contractions begin, an infection develops in the uterus, or spotting suddenly appears, then childbirth occurs according to the traditional scenario, depending on the complication that has developed and the gestational age.

Problems and risks associated with the seam

When the cervix undergoes any surgical procedure, local prostaglandins are released which can stimulate uterine contractions. This reaction can range from mild to severe, including regular labor pains. Intravenous administration of drugs that reduce the tone of the uterine wall can help. Also rare, but still, premature rupture of amniotic fluid can occur, which, unfortunately, cannot be stopped, since this is due to the penetration of infection into the sterile environment of the uterus.

Minor bleeding after this procedure is an absolutely normal event, but due to contraction of the uterus, placental abruption may also occur, in which case this is already quite severe bleeding that requires immediate attention.

Regardless of the type of thread and the method of its application, it is a foreign body and, against the background of some kind of infection, the development of acute inflammation is possible. The most common variant of this complication is chorioamnionitis, which can be prevented by prescribing prophylactic antibiotics. Injury to the cervix can be a consequence of delayed actions by the doctor during the development of contractions, when the pressure is so strong that it ruptures if the suture is not removed in time.

Dystocia, in which scar changes in the tissue structure develop due to the thread. During childbirth with this condition, the cervix does not open on time, often rupturing.