How long is the cervix fully opened? Dilatation of the cervix before childbirth, symptoms, signs

During pregnancy, many changes occur in the female body aimed at successful delivery. The cervix is important, ensuring that the fetus remains in its proper place throughout the entire period. When labor occurs, it forms a path for the baby to pass through.

Only a doctor knows how to determine the dilatation of the cervix. The vagina and uterine cavity are connected by the cervix. The cervical canal passes through it. The place where it flows into the uterine cavity is the internal os, and into the vagina - the external os. The degree of their disclosure is of great clinical importance.

In the short term, there may be a risk of miscarriage. It is diagnosed by detecting dilatation of the cervix during pregnancy, which is an alarming sign. The cause is chronic untreated inflammation in the genital tract, numerous surgeries, and hormonal imbalance.

Signs of cervical dilatation are sometimes noted by the pregnant woman herself. However, often there are no complaints. Symptoms of cervical dilatation are reduced to the occurrence of periodic pain in the lower abdomen, accompanied by discharge mixed with blood.

If such a situation arises, an urgent visit to the doctor is mandatory. With timely diagnosis, miscarriage or premature delivery can be avoided. Dilatation of the cervix before childbirth is a normal stage of preparation for the birth of a baby. Changes can begin from 35 weeks.

Changes in the cervix during pregnancy and the degree of dilatation

Throughout the entire period, the birth canal is prepared for the passage of the child through it. At the same time, the neck changes its consistency due to the formation of new collagen fibers in it, capable of better stretching. It becomes softer and looser. Dimensions change. The closer the term, the shorter the cervix becomes. In the early stages, the amount of mucus produced in it increases, creating a plug. This prevents the development of infection inside the uterus and in the fetus.

During a normal pregnancy, the gynecologist evaluates the condition of the cervix several times:

upon registration;
for short periods of time.

This is done to prevent the development of complications due to its insufficient functioning. This phenomenon is determined during a vaginal examination. The doctor assesses the closure of the external pharynx. The examination is carried out with the II and III fingers of the right hand inserted into the vagina. If it misses at least one of them, then the cervix is dilated by 1 cm, if two - by 2 cm.

Next they look at the internal pharynx. If he misses several fingers, this indicates the onset of labor. That is, when assessing, a gynecologist’s finger passed through the pharynx is equivalent to 1 centimeter of its opening.

During childbirth, examinations are done according to indications (possibly at intervals of 3 hours). The opening of the cervix is their initial period! The adequacy of its development will determine the duration of contractions and further management of the woman in labor.

An important concept is the degree of maturity, which is assessed according to the following parameters:

degree of softening;
size;
patency of the cervical canal;
position.

The higher the maturity, the faster the expulsion of the fetus will begin.

In the first birth, the internal os opens first. The canal in the cervix becomes like a funnel. Then it expands. The neck is shortened and smoothed, the external os is still closed. Then its edges stretch and thin out. It opens during the next contractions. This happens 10 – 12 hours.

When the cervix is dilated by 1 finger in primiparous women, careful observation is necessary before delivery. In multiparous women, the external os is often slightly open in the later stages. This is due to mechanical trauma during the previous passage of the baby. In later stages and during childbirth, the tip of the finger passes through the pharynx.

This is not a pathology. It is possible to dilate the cervix by 2 fingers. During labor, the internal and external os open quickly and almost at the same time, shortening the cervix. The process takes place in 6-8 hours.

The dilation phases begin with the onset of regular labor activity and end with an opening of 10–12 cm and the release of amniotic fluid. The interval between contractions becomes shorter, and contractions increase in duration. The time is different for primiparous and multiparous women. Regular labor activity is considered to be contractions lasting 20-25 seconds every 10-15 minutes.

Opening phases:

The first (latent).
Second (active).
Slowdown.

The first phase is counted from the beginning of a regular rhythm and ends with a dilatation of 4 cm. It lasts 5-6 hours. During a contraction, the pain is tolerable. There may be brown discharge from the cervix during childbirth with streaks of blood, which is caused by injury to small vessels during contractions of the uterus. Medicines are rarely prescribed.

It is possible to administer antispasmodics: papaverine, no-spa. A woman in labor may experience a discharge of a plug, which is a thick mucous discharge streaked with blood. The second phase begins with the opening of the pharynx by 4 cm. Violent labor activity develops. The uterine os opens up to 8 cm within 3-4 hours, 3-5 contractions occur in 10 minutes. They are painful, so doctors often prescribe painkillers.

At this time, the membranes rupture and the waters break. If this does not happen, an amniotomy is performed. The essence of the procedure is to puncture the amniotic sac. The consequence of the active phase is the almost complete opening of the uterine pharynx. The fetus descends to the birth canal.

The deceleration phase begins when the throat opens 8 cm and ends with its full opening. A woman in labor may experience a weakening of labor activity. In primiparous women, the phase reaches 2 hours, and in multiparous women, its absence is observed. Full dilatation of the cervix is 10-12 cm.

How can you influence the degree of disclosure?

Many pregnant women, afraid to carry a child, want to know how to speed up the dilatation of the cervix before childbirth. The gynecologist gives general recommendations:

Drug therapy is carried out only in a hospital setting! After this, labor can begin almost immediately. Such measures are carried out after 40 weeks, when the placenta cannot deliver the necessary substances to the fetus in sufficient quantities.

Acceleration of dilatation in the hospital is carried out in the following ways:

introduction of kelp sticks into the cervical canal;
puncture of the amniotic sac;
medicinal prescriptions.

Kelp sticks are a type of seaweed. When exposed to the moist and warm environment of the vagina for several hours, they draw in fluid and swell. This provides a soft mechanical opening.

This method is used when labor begins and the cervix is dilated by 1 finger. Amniotomy (puncture of the amniotic sac) is performed under sterile conditions. The consequence is the insertion of the fetal head into the pelvic cavity, increasing the pressure “from above” on the cervix. Its maturation is accelerated.

It should be carried out only if there are certain indications: cervical dilatation by 2 cm and weakness of labor. Medicines are used in various forms: tablets, suppositories, gels, injection solutions. They contain prostaglandins - hormones necessary for adequate labor.

The doctor selects the necessary medication and dosage, taking into account the overall picture! Gel and suppositories are more preferable due to the minimum side effects and maximum local effect.

Local medications are prescribed: Prepidil-gel, Prostin E2 gel. They are found in the vagina and have a mild effect. The effect after their use occurs within 30 minutes. Every 6 hours the patient’s condition and the cervix are examined. A positive effect is considered to be a dilation of 3 cm within 6 hours of administration. If this is not observed, the gel is not re-prescribed.

Oxytocin is prescribed intravenously. Its effect develops “on the needle” and lasts up to 3 hours. It is administered when the cervix is dilated by one finger and there is labor weakness. The dose is assessed drop by drop. However, contractions during the administration of this drug are much more painful than during the natural course of labor. Often, for pain relief against the background of oxytocin, doctors resort to spinal (epidural) anesthesia.

Cervical dilatation of 1 or 2 cm after 37 weeks of a normal pregnancy is acceptable and does not require medical intervention. During childbirth, it is an integral part of the entire process. It is impossible to assess its degree at home! This can lead to sad results, because the only way to diagnose is a vaginal examination. How to speed up the dilatation of the cervix and whether it is necessary to explain to the attending physician.

No normal birth occurs spontaneously. In addition to the constantly changing hormonal levels, many more changes occur in a woman’s body. For example, changes in the cervix are noted several weeks before the expected date of delivery. It is this process that ensures the birth of a child, and how severe it will be depends on how well it goes.

The anatomical changes that occur to the cervix in preparation for an early delivery begin somewhere from 32-34 weeks of pregnancy. They are expressed in the fact that this anatomical structure softens significantly along the periphery, but near the cervical canal it is still possible to palpate fairly dense tissue. In those women who are about to have their first pregnancy, during a vaginal examination you may find that the tip of your finger can penetrate the external pharynx. In those giving birth, the patency of the canal allows one finger to penetrate up to the internal pharynx. At approximately 36-38 weeks, almost complete softening of the cervix is observed. Further dilatation is also stimulated by the fact that the fetus presses on the cervix with its own weight (during this gestational period the fetus descends into the pelvis).

The process of opening the cervix begins with the internal pharynx. In primigravidas, the canal becomes similar to a truncated cone, the base of which will face upward. Due to the gradual movement of the fetus forward, its further expansion is observed. In multiparous women, the process of opening the cervix is much easier and faster, due to the fact that already at the end of the gestational period the external os is open by 1 finger. This category of women in labor is characterized by simultaneous opening of the external and internal pharynx.

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The ideal cervix before childbirth - what is it like?

A common feature of the cervix of both first and multiparous women is that it sharply shortens (smoothes out), becomes thinner, and the canal allows 2 or more fingers to pass through. Over time, the cervix becomes fully dilated to 10-12 cm. This makes it possible for the fetal head and torso to pass through the birth canal.

The period of contractions - what happens to the cervix?

This period is the longest - it lasts until the uterus opens to a size that allows the fetus to pass through. The most pressing question for expectant mothers is how much should the cervix open (how many fingers to let through) in order for the birth process to begin?

Dilatation of 2 fingers - when to give birth?

In principle, it can be indicated that before the start of the delivery process, the uterus will be dilated by at least 2 fingers, and at the same time it will be smoothed. But as to whether a woman will begin to dilate to 2 fingers upon reaching the cervix, it is very difficult to say anything - first, it will be necessary to find out how intensively the dilation occurs during the contractile activity of the myometrium.

Characteristics of different periods of contractions. Anatomical features of the uterus before childbirth

The period of contractions is divided into a slow period, otherwise called the latent period, and a fast period (otherwise known as the active phase of contractions). The duration of contractions lasts about 10-12 hours in primiparous women, and 6-8 hours in women giving birth.

The latent phase begins from the moment contractions acquire a certain rhythm - as a rule, they occur at intervals of 1-2 in 10 minutes, the duration of this phase is about 6 hours and there is no pronounced pain syndrome during it. The duration of this phase in primiparous women is always an order of magnitude longer.

The use of medications at this stage is not indicated, but the need to prescribe tocolytics for women in labor whose age is less than 20 or more than 35 years cannot be ruled out. At this time, a dilation of about 3 cm is already observed, but the exact time of the onset of labor cannot yet be indicated, since the alternating contraction of the uterine myometrium with its subsequent relaxation is just beginning. The result of these processes is a shortening of the length of the cervix. Taking into account the fact that the baby’s head is adjacent to the entrance to the small pelvis, the amniotic sac begins to put pressure on the internal os, resulting in its opening.

Is it possible to tell when labor will occur by the size of the cervical dilatation?

The doctor can tell you after what time period the process of delivery begins when the cervix reaches 4 cm dilatation. It is complete effacement and such dilatation that clearly indicate that the active phase of contractions is starting. Regardless of what kind of birth is expected, the duration of this phase does not exceed four hours. Further disclosure is carried out in record time. The speed of this process is about 2 cm per hour for first-time mothers, and 2.5 cm for repeat births. Once the cervical dilatation reaches 5 cm, delivery can be expected within 2 hours, since for normal passage of the fetal head and its body, the dilation must be about 10, and sometimes 12 cm.

What sensations does a woman experience when the cervix dilates?

The pain syndrome during contractions becomes most pronounced after five centimeters of opening. In order to alleviate the condition of the pregnant woman, the following measures are taken:

Non-medicinal: massage; warm bath, relaxing music.
Drug pain relief - the drug can only be chosen by the attending physician.

In the event that, when the cervix is fully opened, the waters do not drain spontaneously, an opening of the amniotic sac is indicated. At the same time, full dilation is possible only with a sufficient level of contractile activity of the myometrium - weak labor activity is an indication for its stimulation. When performing this intervention, extreme caution must be taken, since if the lumen of the cervix is not opened, stimulation cannot be carried out at all - this can lead to serious consequences, including the occurrence of obstetric hemorrhage.

What changes does the uterus undergo before childbirth?

With increasing gestational age, partial replacement of the muscle tissue of the cervix with connective tissue occurs. “Young” collagen fibers appear, characterized by more pronounced flexibility and extensibility than their counterparts outside pregnancy. A certain percentage of them is absorbed, resulting in the formation of the main substance, leading to an increase in the hydrophilicity of the tissue. For the clinical course, this is of great importance, since this process ensures loosening and shortening of the cervix, as well as gaping of the cervical canal. It is thanks to this feature that the so-called smoothing of the cervix occurs.

What problems may be associated with the process of cervical dilatation?

From approximately 37-38 weeks of the gestational period, the physiological dominant of pregnancy gives way to the dominant of childbirth, and the uterus becomes not a womb, but an organ that is entrusted with the main function of expelling the fetus. In this situation, the possibility of a certain psychological barrier cannot be excluded, which, without appropriate preparation, can lead to hormonal imbalance. Because of this, the cervix does not undergo any changes, and the process of preparation for the upcoming birth is disrupted.

In order for the uterus to open fully, regular labor will be required. If labor contractions become weak, the process of cervical dilatation automatically stops. Often, the picture under consideration must be noted with polyhydramnios (overstretching of the uterus is observed, resulting in a deterioration in its ability to contract) or oligohydramnios (there is a flaccid or flat amniotic sac that cannot affect the cervix with the proper intensity).

Similar problems can most often be found in women over 35 years of age. In this case, the so-called tissue rigidity (low elasticity) contributes to the development of pathology. This feature is one of the most unfavorable reasons that often necessitate a cesarean section in women in labor in this age category.

How is the preparation of the cervix for childbirth stimulated?

It often turns out that just before the date of the expected birth it turns out that the pregnant uterus is “not ready” and its artificial preparation for the upcoming process is necessary. This issue becomes much more relevant after the 40th week of pregnancy. This is explained by the fact that it is during this period that the functionality of the placenta is extremely depleted, which can cause fetal hypoxia.

In this case, the issue can be resolved in two ways - with or without the use of medications:

Medication method is quite effective and helps to achieve the desired result in the shortest possible time, however, it can only be implemented in a hospital setting, since its implementation requires medical training.
Introduction of kelp sticks into the cervical canal. They are placed along the entire length of the cervical canal, and after 4-5 hours, under the influence of moisture, they swell, which contributes to mechanical opening. In addition, another useful property of kelp in this situation is its ability to secrete endogenous prostaglandins, which also contribute to the process of cervical ripening. This method ensures the fastest and gentle preparation of the cervix for the process of delivery, which will happen in the near future;
Introduction of synthetic prostaglandin into the lumen of the cervix in the form of suppositories or gel. Provides the necessary clinical effect within 1-2 hours;
In stationary conditions it is carried out amniotomy(violation of the integrity of the amniotic sac). After the water is released, the fetal head descends, which leads to increased pressure on the cervix, due to which dilation occurs faster.

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How to help dilate the cervix at home?

Non-drug method in principle, it can be used at home, but before that you need to carefully analyze all its pros and cons:
Cleansing enema. The use of this method leads to irritation of the posterior wall of the uterus, which provokes contraction of the myometrium. In addition, a relationship has been established between the discharge of the mucous membrane and the proposed procedure - a cleansing enema promotes its rapid discharge, which provokes dilatation of the cervix. However, it is indicated only for those women who are due to be born today or have already passed, but the child does not want to be born;
Sex. This is the most natural stimulant for the onset of labor. Firstly, intimacy promotes contraction of the muscles of the uterus, increasing the intensity of blood circulation in it. Secondly, male seminal fluid contains prostaglandins, which are activators of the contractile activity of the myometrium. This method of stimulation is contraindicated if the mucus plug has already come off, as the likelihood of infection increases significantly;
Moderate physical activity. Long walks in the fresh air, cleaning the house, walking up the stairs. Not allowed for preeclampsia and placenta previa.

After reviewing the information provided, you have learned the reasons for the disruption in the process of preparing the cervix for labor, so you can take preventive measures to prevent such an undesirable phenomenon. In any case, you must remember that first of all you need to take into account the recommendations of your attending physician, since only he knows best the individual characteristics of your body and can decide on the advisability of following one or another management tactics.

The period of childbirth is one of the most important periods in a woman’s life. The organs of the female reproductive system are actively preparing for the process of childbirth. In particular, the cervix. For a favorable course of labor, in order for the fetus to pass calmly through the birth canal, a sufficient distance in the cervical pharynx is necessary.

Definition

The cervix is part of the main organ of a woman. It connects the uterus to the vagina. It consists of three layers: mucous, muscular and outer - connective tissue. Normally, the cervical part of the uterus before birth is about 3 cm long and about 3 cm wide. The cervix contains a pharynx and two walls: anterior and posterior. During pregnancy, the main organ undergoes changes under the influence of hormones - progesterone and estrogen. Before childbirth, the cervix lengthens and becomes less elastic. Blood circulation in its vessels increases, it becomes blue-purple in color.

Before birth

The cervix before childbirth, starting from the 38th week, begins to actively prepare, opening its pharynx. This condition is associated with a decrease in the action of the main pregnancy hormone - progesterone, an increase in estrogen and oxytocin. Her condition is one of the indicators of readiness for the birth of a child. The main changes that are taking place:

The placement of the uterus in the pelvis changes (sinks lower).
Elasticity changes, the cervical part becomes softer.
The length is reduced, even up to 1 cm. The cervix is smoothed, that is, the space for entering the cervix expands.

The dilation of the cervix before childbirth occurs gradually and smoothly.

Inspection

Cervical dilatation is the only reliable criterion of the body's readiness for childbirth. It is determined by an obstetrician-gynecologist in a gynecological chair, starting 1–2 weeks before the expected due date. The woman sits on a chair, the doctor conducts a visual examination, then examines the cervix before childbirth, that is, determines the condition by palpation (feeling) with the hand. The doctor inserts two fingers into the vagina, trying to reach the uterine os and determine the main properties:

Neck length.
Its width.
Elasticity.
Consistency.
The degree of opening of the pharynx (how many fingers it allows through).

Then the doctor, taking into account the above criteria, makes a conclusion about the readiness of the body for labor, that is, determines the properties of the cervical part, the main one of which is the dilation of the cervix before childbirth.

Symptoms of change

A woman does not always feel when the uterus begins to dilate during childbirth. As a rule, this process is painless and physiological. The main symptoms she may experience are:

Feelings of heaviness in the lower abdomen, radiating to the groin and labia, passing on its own.
Symptoms of heaviness in the lumbar region, aching pain.
The discharge of a muco-blood plug that occurred independently.
Regular contractions begin, initially with an interval of 25 minutes, then as they open up to 1 contraction every 5 minutes and one contraction every 1 minute. It is important to keep track of how many contractions occur and at what intervals.

Stages of disclosure

In the dilation of the uterus, I distinguish several stages, characterized by different states of the cervix. Each stage is accompanied by its own sensations. The main stages are as follows:

The first stage is characterized by slow dilation of the uterus, starting with dilation to one or two fingers during the week before birth, reaching dilation before birth 4–6 hours, but not more than 10 cm. The process is accompanied by regular contractions, but rare.
At the second stage, dilation occurs at about 1 centimeter per hour, the cervical part expands to 10 cm or more, contractions occur every minute.
The third stage is characterized by the complete completion of the opening process and full readiness for the birth of the fetus.

1 finger opening

The minimum width to which the uterus opens is 1 finger of the doctor conducting the examination. One finger is approximately 1.5–2 cm. This process occurs at 38 or 39 weeks of pregnancy, that is, it means the period of preparation for childbirth has begun. A woman may feel heaviness in the vaginal area, slight discomfort, nagging pain in the lower abdomen and lower back, which is why she consults a doctor. But 1 finger does not mean hospitalization in a hospital; you can stay at home in this condition.

2 finger opening

If dilatation is 2 fingers or more, hospitalization in the maternity ward is indicated; this means that the period of labor has begun. As a rule, cervical dilatation occurs around 40 weeks, accompanied by regular contractions and pain in the lower abdomen. The woman is admitted to the maternity ward and is regularly examined, monitoring the process of expansion of the pharynx to the size required for childbirth.

The main thing to remember is that if an opening of 2 centimeters occurs earlier than 38 weeks, this indicates premature birth, which is why it requires urgent measures.

Length

The length of the cervix also changes, which is why it is important to determine it. It is determined using ultrasound. Normally it is between three and four centimeters. In preparation for childbirth, the cervix shortens significantly. This is necessary in order to reduce the path for the child as much as possible. In the period from 16 to 20 weeks the length reaches 4.5 centimeters, from 25 to 28 weeks the length is approximately 3.5 cm, and at 32 and thirty-six weeks it shortens to 3 centimeters. This is her normal state and means she is fully ready for labor.

Cervical immaturity

The cervix is called immature throughout pregnancy. Why immature? What signs determine? At this time, it is dense, elastic, and does not allow even 1 finger to pass through the pharynx. And its length is about two centimeters. If, starting from the 38th week of pregnancy, dilation does not occur, the cervix is considered immature, this is already a variant of the abnormal course of pregnancy, which is why it is important to diagnose this condition in time.

It is necessary to use additional methods to stimulate the disclosure process. The mature cervix before childbirth is softened, short and dilated to the required number of centimeters.

Causes of immaturity

Immaturity of the uterus means a condition in which it does not become soft, does not shorten, and does not open in due time. This prevents the onset of normal labor. It is determined to be approximately 39 weeks. Within 40 weeks, the pharynx should open sequentially by 1 finger, then by 2 fingers, and to the point where the palm can pass through. Why the expansion doesn't happen:

Underdevelopment of the pelvic organs, congenital anomalies.
Nervous disorders, feelings of anxiety.
Insufficient production of estrogen hormones and oxytocin.
Strong contractions, muscle spasms.
Insufficient amount of amniotic fluid.
The woman is over 35 years old.

Treatment

If the cervix does not dilate between 35 and 40 weeks, then they try to leave this condition without treatment. Perhaps, due to the characteristics of the body, the process will occur a little later. If at 40 weeks there are no signs that the uterus is dilating, then the problem arises of how to speed up the dilatation of the cervix. They take measures both non-medicinal (exercises that stimulate expansion) and medicinal (medicines, catheter, sticks). Women with type 2 diabetes mellitus and women in labor who have suffered severe gestosis are also treated. Insufficient opening threatens the development of early fetal hypoxia, and possibly asphyxia.

Non-drug treatment

Non-drug treatment includes exercise to stimulate cervical dilatation. They are the initial stage of treatment. You can do regular exercises that are enough in everyday life. Examples of exercises:

Do cleaning, but very carefully, without heavy loads.
Take a walk outside every day.
Swimming is possible.
Regular sex also stimulates the process of uterine dilatation. Because during sex, blood circulation in the uterus improves, and it has also been proven that semen contains substances that speed up labor.

If the fetus is full-term, you can try using a cleansing enema. The water in the enema, when it enters the intestine, stimulates the back wall of the uterus and causes dilation of the cervix.

Drug treatment

The main method of treatment is medication. You cannot prescribe medications for yourself. It is prescribed only by the attending physician, an obstetrician-gynecologist who is confident in the diagnosis of cervical immaturity and believes that it is already necessary for the woman to give birth. Main drugs and methods used:

Preparations of prostaglandin, a hormone that stimulates the relaxation of smooth muscles. It promotes the opening of the uterine os. As a rule, gels with prostaglandins are used: Progestogel 1%. Injected into the vagina several times a day, constantly monitoring the dynamics of the condition. It is also possible to use prostaglandins intravenously. Also, a prostaglandin tablet can act as a stimulant.
The labor hormone - oxytocin (solution or tablet), administered intramuscularly, also stimulates labor and acts faster than prostaglandins.
Kelp sticks are used. The sticks are inserted into the vagina, into the uterine canal. These sticks contribute to its expansion purely mechanically (when the sticks come into contact with liquid, they swell in the channel). Sticks have proven effective but are rarely used.
A Foley catheter, which is inserted into the cervical canal and expands it, also works mechanically. In addition, when a catheter is inserted, a significant amount of prostaglandins is produced. This method works faster than others.

Thus, for the normal course of pregnancy, timely and correct dilation of the uterus during childbirth is necessary. It is important to monitor her condition starting from the last weeks of pregnancy. Only a doctor can diagnose when it has not opened and prescribe appropriate treatment.

Every mother in labor should know the symptoms of timely dilatation of the cervix during childbirth and exercises to speed up labor.

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Medical indications

Before finding out the signs of dilatation of the genital organ, it is necessary to consider its structure. The cervix is the lower part of the uterus, presented in the form of a narrow cylinder connecting the organ cavity with the vagina. In the cervix there is a cervical canal with a pharynx. During pregnancy, there is a mucus plug in the canal. It prevents the development of an infectious process in the uterus, which is the female genital organ intended for bearing a fetus. It consists of the endometrium, middle muscle tissue and serosa. The muscle layer makes up the bulk of the organ. The myometrium is capable of contracting, which is why contractions occur during childbirth.

In this case, the pharynx opens and the fetus is expelled from the uterine cavity. Normal and timely labor, as a rule, does not begin suddenly and violently. Before the birth of a baby, a woman in labor experiences various sensations that indicate the preparation of the uterus and its cervix for childbirth, which is a long and complex process that depends on the interaction of the uterus, its cervix and the state of hormones. In a primiparous woman, the labor process lasts 10-12 hours, and in a multiparous woman - 6-8 hours. In this case, childbirth consists of 3 periods:

contraction - the throat opens;
attempts - the fetus is expelled;
postpartum period - the baby's place is separated.

The longest stage is the period of opening of the uterus. In this case, the woman in labor experiences uterine contractions. During this period, the amniotic sac forms and the baby's head moves forward. The neck of the organ opens.

Phases of the uterine os

The first stage of labor is considered the longest. The uterine os opens during 2 phases: latent and active. The first of which lasts 5-6 hours from the first period. In this case, pain is absent or appears to a minor extent. The frequency of contractions is less than 2 in 10 minutes. The uterus contracts once every 30-40 seconds and relaxes once every 80-120 seconds. After each contraction, the visible part of the cervix is shortened, and the lower segment of the organ is lengthened.

The ongoing processes help fix the baby's head at the entrance to the pelvis. The amniotic fluid is divided into anterior and posterior. During the first birth, the latent phase is longer than during subsequent births. At the end of the phase, complete smoothing of the cervix occurs.

In the next phase, the uterus dilates from 4-8 cm. The frequency of contractions increases to 3-5 times in 10 minutes. The uterus contracts and relaxes for the same period (60-90 seconds). The active phase lasts 3-4 hours. During this period, intense labor activity is observed, the neck of the genital organ opens faster.

The baby's head moves through the birth canal. The cervix has descended down the uterine segment. At the end of the phase, the pharynx opens, the amniotic sac opens, and water pours out. If the cervix has opened to 8-10 cm, and the waters have receded, this is a timely outpouring of water. If the waters have broken and the cervix has opened up to 7 cm, it means early rupture of water. When the pharynx dilates more than 10 cm, amniotomy is indicated.

Symptoms of labor

There are no symptoms when the female genital organ is dilated. This phenomenon can only be determined by an obstetrician-gynecologist by examining the vagina. To find out what happens to the cervix during labor, you need to study obstetric terms. Obstetricians-gynecologists determine the opening of the uterine pharynx using their fingers.

The measurement of the "obstetric finger" is carried out in centimeters. The opening of the cervix in one finger is equal to 2-3 cm. If the uterine os has opened by 3-4 cm, the uterus has opened equally. Regular contractions are indicated by the opening of the cervix to 4 fingers. If it is smoothed, then patency of 5 fingers is allowed.

The first signs of labor appear 2 weeks before the baby is born. The bottom of the organ drops within 2-3 weeks before the onset of contractions. In this case, the fetus is pressed against the pelvis. The woman in labor experiences the following sensations:

easier breathing;
frequent urination;
constipation;
high excitability of the organ;
rare and irregular false contractions.

Cervical assessment criteria

Before giving birth, the uterus opens slowly but gradually over the course of a month. Contractions intensify 1-2 days before birth. In a primiparous woman, the cervical canal opens by 2 cm, and in a multiparous woman - more than 2 cm. To determine the maturity of the cervix, obstetricians-gynecologists use a special Bishop scale. Based on this, the following cervical criteria are assessed:

1. Density - a dense organ is assigned 0 points. If the neck is soft around the periphery, but dense inside, then it is assigned 1 point. The neck, soft outside and inside, has 2 points.
2. Length. If more than 2 cm - 0 points, 1-2 cm - 1 point, less than 1 cm - 2 points.
3. Patency. Closed pharynx - 0 points, patency of the cervical canal to the closed internal pharynx - 1 point, passage of 1-2 fingers beyond the pharynx - 2 points.
4. The location of the cervix relative to the pelvic axis. Direction to the rear - 0 points, offset to the front - 1 point, located in the center - 2 points.

By summing up the points, the maturity of the cervix is assessed. An organ is considered immature if the score is between 0-2. If 3-4 points, the cervix is not mature enough. If 5-8 points, the cervix is mature.

Vaginal examination

To determine the degree of readiness of the female genital organ, an obstetrician-gynecologist examines the vagina. In the maternity hospital, such an examination is carried out every 4-6 hours or in the presence of emergency indications, such as:

amniotic fluid has broken;
weak generic forces;
polyhydramnios;
narrow pelvis;
before regional anesthesia;
bleeding;
painful contractions.

When examining the vagina, the doctor evaluates the thickness and degree of smoothing of the cervix. At the same time, the presence of scars on the soft tissue of the genital tract is determined. An obstetrician-gynecologist evaluates pelvic capacity and amniotic sac.

Based on subjective signs of dilatation, a partogram of labor activity is compiled. This group of signs includes the opening of the throat and contractions. The latter are assessed according to the following criteria:

duration;
power of manifestation;
uterine activity.

Using a partograph, the dynamics of the opening of the pharynx is recorded. The obstetrician-gynecologist draws up a schedule. The horizontal curve displays the duration of labor in hours, and the vertical curve displays the opening of the female genital organ in centimeters. Using the graph, the phase of labor is determined. If the curve rises steeply, then labor is effective.

Opening of the genital organ

The cervix, which opens long before labor, is called isthmicocervical insufficiency. This pathology is characterized by the fact that the uterus and its components do not perform an obturator function during gestation. In this case, the neck becomes soft, shortened and smoothed. This leads to miscarriage. Pregnancy is terminated in 2-3 trimesters.

If the cervix is defective, then it is shortened to 25 mm at 20-30 weeks of gestation. ICN can be organic and functional. The first pathology develops after a cervical injury (abortion, rupture during childbirth). The functional form is associated with hormonal imbalance or high load on the cervix.

But if the cervix dilates by 1-2 fingers at 28 weeks, then the pregnancy can be maintained or prolonged until the birth of a viable child. In such a case, bed rest and complete emotional rest, taking antispasmodics and tocolytics are indicated. Treatment aims to produce surfactant in the baby's lungs to speed up their maturation. For this purpose, the pregnant woman is prescribed glucocorticoids.

Therapy prevents subsequent premature cervical dilation. The mother is given sutures, which are removed at 37 weeks. If the cervix is immature, long and dense, then medication and other methods are used. The woman in labor is injected into the vagina or cervix with a special gel and suppositories with prostaglandins (to speed up the process of cervical ripening). At the same time, the excitability of the female genital organ increases. A similar technique is used during childbirth if a weak birth act is detected. When administered locally, there are no adverse reactions.

Additional techniques that can be used to shorten the prenatal period:

1. Use of kelp - sticks made from dried algae with high hygroscopicity. The required number of sticks is inserted into the channel to fill it tightly. They absorb liquid, swell, stretch and open the neck.
2. Catheter and balloon - they are inserted into the cervical canal. The balloon is filled with air and left in the canal for a day. Under mechanical influence, the cervix opens and prostaglandins are produced.
3. Enema - a cleansing manipulation increases the excitability of the organ, accelerating the birth act.

You can prepare your cervix for childbirth at home. It is recommended to take long walks in the fresh air. Walking promotes presentation and fixation of the baby at the entrance to the pelvis. In addition, the opening of the genital organ is stimulated. At the same time, a woman should monitor her intestines and urinary tract, avoiding constipation. The diet includes salads and a decoction of raspberry leaves. At the same time, it is recommended to stimulate the nipples.

You can speed up labor by doing exercises such as:

swimming;
walking up stairs;
turns and bends of the body;
massage of the little finger and ear;
warm bath;
breathing exercises;
gymnastics that strengthens the perineal muscles;
yoga.

A woman in labor can exercise on an exercise ball. This speeds up the opening of the cervix. Sex in the last week of pregnancy speeds up the process of cervical ripening. But intimate life is indicated if the woman in labor has a whole amniotic sac and there is a mucus plug in the cervical canal. Sex is effective because:

during orgasm, oxytocin is released, stimulating the activity of the uterus;
sperm contains prostaglandins, which have a positive effect on the process of cervical maturation.

Before using the above methods, it is recommended to consult with your doctor. A woman in labor should know that when the uterus is dilated by 8 cm, the desire to push appears. Pushing refers to the voluntary contraction of the abdominal muscles. But if the cervix has not dilated to 10 cm, and the baby’s head has not dropped to the bottom of the pelvis, pushing is prohibited.

Performing gymnastics

In order for the birth to be easy and without gaps, it is recommended to perform special exercises when the first contractions appear. This exercise relieves pain, stimulates the uterus, relieves tension and stress. During pregnancy, it is recommended to constantly perform special gymnastics, which:

promotes the development of mobility and flexibility of the pelvic bones, preventing the occurrence of back pain during labor;
provides comfortable sitting in the maternity chair by stretching the thigh muscles;
prevents the appearance of hemorrhoids after childbirth by maintaining the tone of the pelvic and vaginal muscles;
promotes timely dilatation of the cervix.

To give birth to a baby with minimal consequences and without pain, it is recommended to perform exercises for each muscle group from the 5th month of pregnancy. The pelvic bones can be prepared for labor in the following way:

1. The woman in labor kneels, leaning on her hands.
2. Palms are placed at a distance of 30 cm from each other, and knees at a distance of 20 cm.
3. Hips are perpendicular to the floor.
4. The back slowly bends, and the buttocks rise as high as possible.
5. The exercise is performed with a deep breath.

1. Feet join and knees move apart.
2. Hands clasp ankles.
3. The body bends forward.

breaststroke swimming relieves stress and weight from joints;
walking and squatting - gradually promotes the lowering of the fetus along the canal;
riding on a swing.

The above methods are the impetus for the natural birth of a full-term baby. With the help of such exercises, the shape of the woman in labor is maintained. But if contractions have already begun, special gymnastics are indicated to relieve pain. At the same time, it provides a comfortable state during labor, reduces tension in the nervous system and muscles, and provides the uterus with the maximum amount of oxygen.

The following exercises are allowed between contractions:

1. Place your feet shoulder-width apart, with your arms down. As you inhale, the upper limbs spread to the sides, and as you exit, they lower. The brushes are shaken.
2. In the same starting position, pull your elbows back, lifting your legs forward one by one.
3. In a similar starting position, move your arms and torso to the side.
4. Sit on a chair with your knees bent and your soles touching. The knees are spread apart.
5. Lying on the floor, bend your legs one by one, while tilting your knees in different directions.
6. Slow walking with cross steps.

Methods for eliminating pain

To reduce pain, breathing exercises are indicated during childbirth. With its help, the body of the fetus and the woman in labor is saturated with oxygen. Before giving birth, it is recommended to perform relaxing breathing exercises: inhale through the nose, and after a few minutes exhale through the mouth. You need to breathe smoothly.

The neck of the reproductive organ plays the role of a ring that closes the entrance, holding the child inside. Over the course of 9 months, the baby grows and the volume of amniotic fluid increases. The pressure on the pelvic bones is increasing. The organ does not always withstand the load. Symptoms and signs of cervical dilatation during early pregnancy are common. The phenomenon is dangerous and quite common. If timely treatment is not taken, a miscarriage will occur.

During the course of bearing a child, disruptions occur in the body. Muscle tissue is partially replaced by connective tissue. New collagen fibers begin to form. Unlike the previous ones, they are more flexible and elastic. A small amount is absorbed to form the main substance. You can tell that the cervix is dilating by its appearance. It looks loose, shortened, with a visible canal.

The organ begins to prepare for labor at 32–34 weeks. This is manifested by softness on the outside. The channel remains quite dense. Complete softening of the cervix occurs at 36–38 weeks. The baby enters the pelvis at this stage of pregnancy. Pressure on the reproductive organ increases, forcing it to open.

The process begins with the internal pharynx. The baby moves along the birth canal, which has the shape of a cone with a wide side at the exit. The tissues gradually stretch. For women who give birth repeatedly, the procedure is faster. The canal opens on both sides at the same time; the opening of the cervix is practically not felt during pregnancy.

Immediately before the birth process begins, it becomes exhausted and looks too short. 2 or more fingers will fit inside. However, the action doesn't stop. The limit is considered to be 10–12 cm. This width of the hole is required for the successful exit of the baby’s head. The degree of maturity of the cervix is determined according to the Bishop scale.

There are 3 types:

immature;
maturing;
mature.

The first is characterized by density, length greater than 2 cm, and closedness of the external pharynx. The second corresponds to external softness and internal hardness. Shortening occurs to 1 - 1.5 cm. Half of the path becomes passable. The third type is characterized by softness and the ability to insert 2 fingers.

A couple of hours before the start of labor, cramping pain appears when the cervix dilates. They are not long-lasting, low-intensity, and do not cause structural changes. The normal duration is about 6 hours.

Signs of ICN

It is difficult to consider isthmic-cervical insufficiency in the second trimester of pregnancy. The doctor obtains data from examining the vagina using ultrasound, performing an examination using a speculum. You need to find the problem quickly so that a miscarriage does not occur.

Can you feel the dilatation of the cervix? Yes and no. Some women in labor arrive at the maternity hospital with a 2 cm dilation, feeling nothing. Others experience pain when contracting.

Signs of cervical dilatation in the second trimester:

bleeding;
pain in the lower abdomen;
shortening, softening;
pressure on the vagina;
on examination the amniotic sac is visible;
length discrepancy with normal parameters;
the pharynx is open.

If at least one of these symptoms is detected, immediate treatment is required. Two or more are considered a signal for the woman in labor to be admitted to the clinic. Diarrhea and nausea are also observed when the cervix dilates. Indicates insufficient protrusion of the amniotic sac.

Accommodation options:

on top of the internal pharynx;
on the line of the hole, but invisible to the eye;
in the canal, visible upon examination;
moved into the vagina.

What does it feel like when the cervix dilates?

nagging pain radiating to the thighs;
feeling of discomfort due to the drooping baby;
spasms in the vagina.

A gynecologist is able to diagnose ICI having:

information about previous miscarriages that occurred in the last trimester of pregnancy;
data on premature termination of pregnancy by labor in the early stages;
information that conception occurred after IVF;
results of prolapse of the membranes;
mirror inspection indicators.

Quite often many signs are absent. Therefore, it is difficult to understand that the cervix is opening. Ultrasound examination is considered the most effective method. The method will promptly indicate the deficiency and also determine why it appeared.

Sometimes women end up in the maternity hospital with an opening of 1 - 2 cm. They are not even aware of the ongoing process. Everything happens unnoticed, and the cervix begins to dilate without contractions. Stretching and tingling are rarely observed.

Causes

Premature dilatation of the cervix in early pregnancy often results in miscarriages. Softening provokes expansion, opening. It is difficult for the fetus to hold on.

There are 2 types of ICN:

organic;
functional.

What a particular woman will have will be determined by the reasons that formed her. Organic is also called traumatic because it is caused by injury. The cervix loses its elasticity and becomes scarred.

abortions;
miscarriages;
cervical injuries;
treatment of polyps, erosion;
scraping.

Scar tissue cannot stretch. It is made up of connective fibers. They are characterized by increased rigidity. The ability to contractility is lost. As a result, the baby is not held inside. The ICN appears.

Functional call:

changes in hormones;
polyhydramnios;
pathologies of the reproductive organ;
imbalance of tissues.

A large amount of androgen produced or a small amount of progesterone leads to hormone disruption. The consequence is detected at the 11th week of pregnancy. The cervix weakens and opens.

Large accumulation of water is also considered a serious cause. This phenomenon is observed during multiple pregnancies. The load on the reproductive organ increases, and insufficiency occurs.

These reasons contribute to varying degrees of softening. The uterus prepares for childbirth ahead of time and becomes pliable. As the baby grows, the ability to stay inside decreases. Functional failure affects women who have problems with the functioning of the ovaries. Congenital ICI is also sometimes present.

Each woman experiences this disease individually. Instead of one reason, it can be caused by two or more. In any case, it is difficult for the child to hold on, he heads towards the exit. As it goes down, the pressure increases. Low position leads to infection. As a result, a miscarriage or premature labor occurs.

Treatment

The doctor determines the exact causes of the deficiency, then recommends a course of therapy. For functional symptoms, hormonal medications are often prescribed. They restore hormone levels in 1–2 weeks. After the situation improves, treatment does not stop.

How to check the cervix before childbirth:

manual inspection;
ultrasound diagnostics.

It is necessary to observe bed rest when all signs of opening of the cervix before childbirth are observed in a woman in the early stages of bearing a child. The gynecologist recommends complete calm. Any load should be limited.

Conservative treatment methods involve the use of a Meyer ring. The product is made of plastic. Goal: To control the baby's pressure on the cervix. The manipulation is suitable for women in labor with a small opening at a gestational age of 28 weeks or more. Thanks to it, the baby's weight is evenly distributed. This method is used as an auxiliary method.

At an earlier stage, in the absence of infectious diseases, surgical intervention is prescribed. The goal is to place sutures on the cervix so that dilation does not occur until after birth. No discomfort is felt during surgery. Anesthesia is administered in advance. The suture material is removed before labor begins, when the amniotic sac is opened.

Both types of treatment for the disease involve the prescription of antibacterial drugs. They are needed to exclude birth and prevent an infectious process. To enhance effectiveness, antispasmodics are prescribed. Reduce hypertension with tocolytic agents. Hormonal medications are prescribed if an opening is observed due to a malfunction of the endocrine system.

Stimulation of dilatation during labor

With a mature cervix, labor begins at 38 weeks and ends with the birth of a baby. Sometimes doctors stimulate the process. Indications are premature, late labor. The onset can be spontaneous, weakly occurring, with an unexpected stop.

How to open the uterus before childbirth:

by administering medications;
use amniotomy;
manually.

The obstetrician notes the weakness of the process, stimulates it, if the reproductive organ stops contracting, contractions are not enough to fully open. The doctor uses medications when 12 hours have passed after the water has broken, and the birth process has not begun. Such stimulation is carried out carefully under the supervision of medical staff. The absence of an allergic reaction to drugs is checked prematurely.

Signs of the need to stimulate uterine dilatation during labor:

hypertension;
gestosis;
early release of water;
stretchiness;
weak contractions, complete absence;
the reproductive organ does not open;
heart failure;
placental abruption;
late toxicosis.

The obstetrician, based on the health status of the mother in labor, makes a decision on stimulation. If symptoms of premature cervical dilatation appear during pregnancy in the third trimester, the doctor will recommend that the woman in labor go to the clinic for a couple of weeks. Medical staff will monitor the condition of the woman and baby. If necessary, uses the surgical method.

The method of amniotomy is widely known. The idea is to pierce the bubble. The main indication for manipulation is suddenly stopped dilatation, which has already occurred by 2 cm. Piercing will speed up labor. The amniotic fluid will recede and the pressure on the pelvic bones will decrease. The method is considered safe and absolutely painless.

Another method of stimulation is to manually dilate the cervix. Special tools are often used - reamers. A prominent representative is an inflatable balloon filled with liquid. He acts on the neck, achieving an opening. When using the method, there is a danger of the bubble bursting. Therefore, it is carried out in case of emergency.

Straightening the cervix before childbirth occurs on the eve of the process. If during the examination the gynecologist discovers that this has not happened, the procedure is performed manually. Sometimes accompanied by severe pain. Manipulation is necessary to facilitate the child's exit.

Signs of dilatation begin unnoticed in many cases. Then a nagging pain sensation appears, the mucous membrane and blood plug come away. The main indicator of approaching labor is uterine contractions. If such symptoms become apparent in the middle of pregnancy, tell your gynecologist. There was a threat of premature birth of the baby.