Isthmic-cervical insufficiency (ICI) during pregnancy - Causes, symptoms and treatment. Isthmic-cervical insufficiency (ICI) - how to maintain pregnancy

Pregnancy without complications and pathologies is every woman’s dream. The harsh reality, unfortunately, often presents unpleasant surprises. One of them may be isthmic-cerebral insufficiency, or abbreviated ICI.

What is ICN and why is it dangerous?

ICI during pregnancy is relatively rare, occurring in only 1-9% of women. What is hidden behind this phrase? To understand what it is and what processes lead to this pathology, you need to understand the structure of the uterus.

It consists of a body - a muscular hollow sac in which the child is born, and a cervix that closes the entrance to the uterus. Together with the isthmus, the cervix forms the first part birth canal. Both the neck and isthmus consist of two types of tissue: connective and muscle.

Moreover muscle concentrated in the upper part of the cervix, at internal pharynx uterus. The muscles form a sphincter ring that does not release from the uterus ovum ahead of time.

However, in some cases, this very muscle ring is unable to withstand the increasing load: the weight of the fetus and amniotic fluid, uterine tone. As a result, under the pressure of the fertilized egg, the cervix shortens and opens prematurely.

Why is ICN dangerous during pregnancy? Firstly, dilated cervix uterus provokes fetal descent , the fetal membrane enters the uterine canal. During this period, it can open literally from any sudden movement.

Secondly, a woman's vagina is never sterile. It always contains various bacteria, and often infections. What happens in the end infection of the membranes . At this point it becomes thinner and can rupture simply under the weight of amniotic fluid.

The opening of the membranes and the release of water cause the onset of labor. Thus, ICN becomes one of the most common causes miscarriages on later (up to 22 weeks), or premature birth (from 22 to 37 weeks).

Typically, ICI develops between 16 and 27 weeks. IN in rare cases pathology can develop earlier, even at 11 weeks.

Types and causes of isthmic-cervical insufficiency

What are the causes of ICN? They can be very different, and depending on the reasons, they distinguish between traumatic and functional failure.

With the first view, everything is clear from the name. Traumatic ICN develops if the muscles of the cervix have been injured in one way or another. What can cause injuries? Any procedure associated with dilation of the cervix is fraught with injury. These include abortions, curettage after miscarriages, and diagnostic curettage. In addition, the muscles of the cervix can be injured during childbirth, as well as after IVF (in vitro fertilization).

In this case, the mechanism of formation of ICI during pregnancy is extremely simple: at the site of any injury, a scar of connective tissue appears. Unlike muscular connective tissue unable to stretch, this becomes the cause of insufficiency.

WITH functional ICN everything is somewhat more complicated. Its reasons may lie in various factors. However, most often this type deficiency is associated with hormonal imbalances. Usually, we're talking about about a lack of progesterone, or about an excess of male hormones - androgens. By the way, this is the second most common cause of ICI.

In this case, deficiency begins to develop in the early stages, from about 11 weeks of pregnancy. This is due to the fact that at this time the fetal pancreas begins to work. She produces male hormones, and if the mother has an increased number of them or is sensitive to them, the consequences will not slow down: the muscles in the cervix weaken and the cervix opens.

ICI can also develop for more prosaic reasons. For example, if the pregnancy is multiple or there is polyhydramnios. In this case, the load on the cervix is greater than with normal pregnancy, which can also lead to failure. Do not forget about pathologies of uterine development.

Symptoms of ICN

Unfortunately, isthmic cervical insufficiency is asymptomatic. Only in some cases, ICI in the early stages can manifest itself in much the same way as a threatened miscarriage: spotting bloody discharge, nagging pain in the abdomen, bursting sensations in the vagina. Typically, ICN has no symptoms during pregnancy.

Diagnostics of ICN

Due to the fact that ICI is practically asymptomatic, it is very difficult to diagnose. To do this, you need to regularly visit a gynecologist and carry out vaginal examination every visit. Unfortunately, many doctors believe that it is enough to examine the birth canal during registration and already in the maternity hospital before childbirth.

As a result, the woman attends a consultation, but the doctor only measures weight, abdominal size and blood pressure. In such conditions, a woman may find out about the diagnosis of ICI during pregnancy when it is already too late.

Often this is already known about a miscarriage or premature birth with the help of a special study: hysterosalpingography - an x-ray of the uterus and tubes using a radiopaque substance.

Of course, if a woman has previously had this pathology, her health will be monitored much more closely. However, you can insist that a vaginal examination be performed every time you visit a gynecologist.

During the examination, the doctor should pay attention to the softening of the cervix, reducing its length by initial stage ICI, and cervical dilatation at a later stage.

One question remains: what length of the cervix is considered normal? Much depends on the period, because closer to childbirth, a decrease in length is considered normal:

at 24-28 weeks: 35-45 mm;
after 28 weeks: 30-35 mm.

However, the doctor has only his own sensations and a gynecological speculum at his disposal. And if the external os of the uterus is not yet open, the gynecologist can only assume ICN, and more accurately make a diagnosis using ultrasound.

The study is carried out using a vaginal sensor. The following factors are noted that help determine whether isthmic-cervical insufficiency occurs:

cervical length;
presence of opening of the internal pharynx.

If the internal pharynx has already begun to open, and the external pharynx is still closed, the cervix takes on a V-shape, and this is clearly visible on an ultrasound. There are several additional tests that can help clarify the diagnosis. difficult cases. For example, a woman may be provoked to cough or put pressure on the fundus of the uterus (that is, in her top part). This necessarily affects the cervix, and ICN makes itself felt.

Treatment of ICN

Only after the diagnosis has been accurately established, as well as the cause of the pathology, can treatment for ICI during pregnancy begin. Without knowing the cause, as in any other case, it will not be possible to select an adequate treatment.

First of all, we distinguish functional ICN, which occurs against the background hormonal imbalances. In this case it is assigned hormone therapy designed to restore normal level hormones. The medications are continued for 1-2 weeks, after which the patient is re-examined. If the situation has stabilized and the cervix no longer dilates, then the medications are continued, while maintaining constant monitoring of the pregnant woman’s condition. If the situation worsens, other treatment methods are preferred.

Second way treatment of ICN during pregnancy - installation of a relief pessary , it is also called Meyer's ring. In fact, it is a small plastic structure of a special shape. It is placed in the vagina, and it supports the cervix, redistributes the weight of the fetus and amniotic fluid, and allows the pregnancy to continue.

The Meyer ring can be installed at almost any time when it is generally advisable to delay childbirth. It is used in cases of untreated ICI due to multiple pregnancy or polyhydramnios. If the ICI is pronounced, then this method can only be used as an auxiliary one.

No matter how useful a pessary is, it is still foreign body, which can provoke vaginal dysbiosis. To avoid this, the woman is regularly smeared and undergoes preventive sanitation with antiseptics. In rare cases, antibiotics may be prescribed.

The ring is removed after 37 weeks, or if labor begins.

In cases where a plastic ring is clearly not enough, a next method treatment of ICN during pregnancy: suturing . The internal os of the uterus is narrowed and stitched with non-absorbable threads. Silk ones are most often used.

How long does it take to perform the operation? In this case, everything is determined individually. Most often, stitches are placed in the early stages, that is, before 17 weeks. Depending on individual indications, the operation can be performed later, but no later than 28 weeks. In this regard, a pessary compares favorably with sutures; it can be installed at a later date.

Stitching is a fairly serious operation. It is performed in a hospital setting, under local, short-term anesthesia. Special attention is given to the selection of anesthesia. It should not harm the child. To avoid complications, a smear for microflora must be taken a few days before the operation, and the vagina is sanitized immediately before the procedure. Smears and sanitation are also done after suturing.

Increased tone of the uterus with sutures already applied is a serious risk. Therefore, patients are often prescribed drugs that reduce uterine tone, such as magnesia and ginipral, as well as antispasmodics, for example, papaverine.

Stitches can be removed in a simple gynecologist's office on a chair. This is done in the following cases:

At 38 weeks, since the pregnancy is already considered full-term, and labor can begin at any time;
If stable labor begins at any time;
If the amniotic fluid breaks or begins to leak, since in this case there is a risk of infection of the fetus, and we are already talking about an urgent delivery;
If bleeding is observed;
When cutting seams.

If the sutures are not removed at the appropriate time, but due to complications that arise, doctors correct and treat these complications. After this, a decision is made whether to re-correct.

Unfortunately, this procedure, like almost all medical procedures, there are a number of contraindications. Including:

various serious illnesses mothers;
pathologies of fetal development;
placenta previa.

Compliance with the regime

Any pathology during pregnancy requires not only timely treatment, but also compliance with one or another regime. Isthmic-cervical insufficiency is no exception. A woman with this pathology needs to give up unnecessary physical activity, avoid sexual intercourse, and lie down more. Let your loved ones do household chores for you. Remember to take all your prescribed medications on time.

Not the least role is played by psychological attitude women. During this period, optimism, faith in success and a positive outcome of the situation are very important. And, of course, don't skip routine checkups. Your health and the birth of your child depend on this.

Childbirth with ICN

Since ICI is essentially the inability of the muscle ring to remain closed, labor with ICI often progresses rapidly. Of course, here too everything is individual, and the time of birth may vary.

Timely therapy and adherence to the regimen usually help to the expectant mother bring the child to term. Then the woman is admitted to a hospital in advance, where she is under constant supervision.

In cases where labor does begin before term, the situation is somewhat more complicated. It is very important to get to the maternity hospital in a timely manner, and at the same time be fully armed, that is, at least with your father’s documents: exchange card, policy, passport. The exchange card is especially important because it contains information about your pregnancy that obstetricians need to correct management childbirth Therefore, it is especially important for women with ICI to carry all documents with them.

Fortunately, isthmic-cervical insufficiency is still quite rare. A modern medicine allows you to solve this problem, and without harm to the woman and her baby. Therefore, you should not be afraid of this diagnosis. The main thing is to follow all the recommendations of your doctor.

Replies

Isthmic-cervical insufficiency (ICI) is the main cause of miscarriages in the second trimester of pregnancy. ICI is the dilatation of the cervix, which during pregnancy is regarded as a threat of miscarriage or the onset of premature labor. This pathological condition uterine cervixes are often diagnosed in patients with persistent miscarriages or preterm pregnancy.

Causes

The mechanism for the development of this condition of the cervix is quite simple. The fact is that as the fetus grows, the uterus increases approximately 20 times, and the volume of its cavity reaches an increase of 500 times. At the same time, the cervix experiences enormous pressure!

If she is healthy, then she softens and shortens towards the end of pregnancy, that is, she is able to withstand such a test. If there is any anomaly on the cervix, then its softening and opening occurs much earlier, and this is fraught with leakage of amniotic fluid, miscarriages and very early birth.

The reasons that can provoke the development of isthmic-cervical insufficiency are divided into anatomical and functional. TO anatomical reasons include traumatic injuries cervix of various origins– ruptures sustained during childbirth large fruit, obstetrics, improper suturing and the formation of rough scars, etc. birth defects cervical development, infantilism, increased amount androgens, congenital dysplasia fabrics are functional reasons development of ICN.

In addition, the risk of developing isthmic-cervical insufficiency is massive hormonal preparation female body before in vitro fertilization.

Symptoms

Such a pathological condition of the cervix can only be detected by gynecological appointment when viewed using mirrors or digital examination, since most often ICI is asymptomatic. Only in some cases, a pregnant woman may complain of slight discomfort in the vagina, a feeling of heaviness in the lower abdomen, and the presence of a small amount of bloody discharge.

About everyone unpleasant sensations It is necessary to inform the doctor, since in the presence of ICN, a miscarriage can be provoked by coughing, fetal movement, or lifting heavy objects.

When making a diagnosis of “Isthmic-cervical insufficiency”, the doctor is primarily based on data from the anamnesis, examination and instrumental research. From the anamnesis (oral interview), the doctor learns about previous injuries to the cervix, miscarriages, difficult childbirth, etc. Examination allows you to identify any deformation, softening or opening of the cervix, or its pathological shortening.

If ICI is suspected in a pregnant woman, the doctor prescribes additional research using ultrasound. During this study, the size of the cervix, the condition of the internal os are determined and the general state isthmus of the uterus.

Treatment

Treatment of isthmic-cervical insufficiency can be carried out by two methods - surgical and conservative, and their combination is also possible.

Surgical treatment of cervical insufficiency in pregnant women involves applying sutures that prevent the internal os from opening. This operation is best performed at the 17th week of pregnancy, since it is at this time that ICI manifests itself and the risk of miscarriage is very high. If the operation was successful and no complications were observed after it, the sutures are removed immediately before childbirth, at approximately 37 weeks.

After the operation an appointment is made medicines, reducing the tone of the uterus (ginipral) and, if indicated, carry out hormone therapy.

During pregnancy, it is possible to correct the condition of the cervix with the help of unloading pessaries - this is conservative method treatment of ICN. An obstetric unloading pessary is a silicone or plastic structure that is inserted into the vagina at early.

The pessary helps reduce stress on the cervix and support the growing fetus. It is removed before childbirth - at 37-. This is very effective method correction of the condition of the cervix, which is absolutely safe for the pregnant woman and the unborn child.

So we talked on the www.site about what isthmic-cervical insufficiency of the cervix during pregnancy, symptoms, and treatment were considered. The most important thing in the treatment of isthmic-cervical insufficiency is the prevention of complications. If this disease is present, a pregnant woman should carefully monitor the condition of her body, strictly follow all the recommendations of her obstetrician-gynecologist and take all medications that he prescribes.

Yulia Ermolenko, www.site
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ICN during pregnancy

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

Occurrence of ICN
Indirect causes of isthmic insufficiency cervical canal
Symptoms of ICI during pregnancy
The mechanism of development of isthmic-cervical insufficiency of the cervix
Methods for correcting ICI
Application of circular sutures for isthmic-cervical insufficiency
Unloading pessary for isthmic-cervical insufficiency
How is a pessary selected?
Tactics of pregnancy management with ICI
How many weeks is the pessary removed?

Occurrence of ICN

In the structure of late miscarriages and premature childbirth ICN occupies significant importance. Isthmic-cervical insufficiency is common according to data from various sources from 1 to 13% of pregnant women. In women with a history of preterm birth, the incidence increases to 30–42%. If previous pregnancy ended at the period -, then the subsequent one in every fourth case will not last longer without correction and treatment of the causes.

ICNs are classified by origin:

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

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

Indirect causes of isthmic-cervical insufficiency

Predisposing factors for deficiency cervical region birth canal are scar changes and defects formed after injuries in previous births or after surgical interventions on the cervix.

The causes of isthmic-cervical insufficiency are:

birth of a large fetus;
birth of a fetus with breech presentation;
overlay obstetric forceps during childbirth;
abortions;
diagnostic curettage;
cervical 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 disruption of the hormonal balance necessary for correct flow pregnancy. Shift hormonal balance happens as a result:

Hyperandrogenism is an excess of a group of male sex hormones. The mechanism involves fetal androgens. At week -27, it synthesizes male sex hormones, which, together with maternal androgens (they are produced normally), lead to structural transformations of the cervix due to its softening.
Progesterone (ovarian) deficiency. – a hormone that prevents miscarriage.
Pregnancy that occurs after induction (stimulation) of ovulation by gonadotropins.

Correction of isthmic-cervical insufficiency of a functional nature allows you to successfully maintain pregnancy through therapeutic means.

Isthmic-cervical insufficiency during pregnancy and symptoms

It is precisely because of the absence of pronounced symptoms that isthmic-cervical insufficiency is often diagnosed after the fact - after a miscarriage or premature termination of pregnancy. The opening of the cervical canal is almost painless or with mild pain.

The only subjective symptom of ICN is an increase in volume and change in the consistency of discharge. In this case, it is necessary to exclude leakage of amniotic fluid. For this purpose, arborization smears and amniotests are used, 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 visible during a vaginal examination performed during registration in the 1st trimester of pregnancy. The study determines:

length, consistency of the cervix, location;
the condition of the cervical canal (it allows a finger or its tip to pass through, normally the walls are tightly closed);
location of the presenting part of the fetus (in later stages of pregnancy).

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

How does isthmic-cervical insufficiency develop?

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

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 ICI

Surgical ICN correction occurs by applying a circular suture. For this, mersilene tape is used - a flat thread (this shape reduces the risk of cutting through seams) with two needles at the ends.

Contraindications to suturing for isthmic-cervical insufficiency:

suspicion of leakage of amniotic fluid;
fetal malformations incompatible with life;
pronounced tone;
and bleeding;
developed chorioamnionitis (with isthmic-cervical insufficiency, there is a high risk of infection of the membranes, fetus and uterus);
suspicion of scar failure after cesarean section;
extragenital pathology, in which prolongation of pregnancy is inappropriate.

What are the disadvantages of surgical sutures for ICI?

The disadvantages include:

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

Carrying a child is a physically difficult process for every woman. During pregnancy, complications often arise that ultimately end well for the expectant mother and her child or lead to the death of the fetus and problems in reproductive system women. One of serious complications, which occurs in women in very rare cases - isthmic-ecclesiastical insufficiency. In a nutshell, this is the opening of the membranes, leading to a miscarriage in the later stages of pregnancy (up to 22 weeks). Read more about the symptoms and causes of this pathology in today's article.

The diagnosis of isthmic-cervical insufficiency (ICI) during pregnancy sounds scary. But, first of all, it is worth noting that this pathology is extremely rare, occurring in approximately 8% of women, and with proper treatment it does not always end in miscarriage and fetal death.

Let's take a detailed look at the structure of the female reproductive system in order to understand exactly what processes occur in the presence of isthmic-cervical insufficiency.

The uterus consists of a muscular, hollow body in which the child is located throughout the entire period of gestation, the isthmus and cervix, which close the entrance to the uterus. Together these parts form the first part of the birth canal. The cervix and isthmus of the uterus consist of:

connective tissue;
muscle tissue.

The muscle tissue located in the upper part of the cervix, closer to the internal os, forms a sphincter ring. It is what holds the fertilized egg inside the uterus and prevents it from dropping prematurely.

However, in rare cases, the sphincter ring “fails” and cannot cope with the increased load. Most often, this happens due to:

fetal weight;
weight of excess amniotic fluid;
increasing the tone of the uterus.

As a result of such processes, the muscle ring shortens and opens prematurely. This pathology is called isthmic-cervical insufficiency.

This anomaly is dangerous because it provokes the descent of the fetus and its placement in uterine canal. Wherein, amniotic sac can burst open from literally any movement. That is, a woman with ICI is constantly at risk of premature birth and miscarriage.

In addition, even if a woman spends the rest of her pregnancy immobile, there is still the possibility of an autopsy. amniotic sac. The fact is that a woman’s vagina is never sterile - it always contains a certain set of bacteria, and sometimes infections. As a result, infection of the fetal membrane occurs. In this case, the walls of the amniotic sac become thinner and can rupture under the weight of water or the fetus.

The opening of the bladder and the release of water provokes labor. That is, isthmic-cervical insufficiency is the most common cause of miscarriage during the period of gestation up to 22 weeks or premature birth from 22 to 37 weeks.

Most often, the first signs of ICI can be detected at 15-26 weeks. But there are also more serious cases of isthmic-cervical insufficiency, which begins to develop as early as the 11th week of pregnancy.

Symptoms of ICI during pregnancy

Unfortunately, it is impossible to recognize the signs of ICI during pregnancy on your own. After all, this anomaly is asymptomatic and does not affect the woman’s well-being. Very rarely, in approximately 0.02 cases, ICI can manifest itself as:

spotting bloody discharge;
nagging pain in the lower abdomen;
distension inside the vagina;
cough;
sensation of pressure in the upper part of the uterus.

Isthmic-cervical insufficiency during pregnancy: diagnosis

Because isthmic-cervical insufficiency does not cause symptoms during pregnancy, it is very difficult to diagnose. For correct setting This diagnosis requires constant vaginal examination by a doctor. Unfortunately, today there is a tendency among doctors that during a routine examination of a pregnant woman, a vaginal examination is not performed, but only weight, abdominal volume, blood pressure and pulse are measured. With such an observation, it is unrealistic to diagnose isthmic-cervical insufficiency. That is why, when visiting a gynecologist, insist on a vaginal examination and examination of the birth canal, so as not to find out about the presence of ICI after a miscarriage or premature birth through hysterosalpinography ( x-ray uterus and tubes).

If you have previously had a miscarriage, then if you have ICN, the second pregnancy should be closely monitored medical personnel. During examinations, the gynecologist in mandatory should check the degree of softening of the cervix, systematically measure its length and dilatation, so that in case of repeated ICN, the pathology can be recognized in time and measures taken to preserve the fetus.

Also, the woman herself should be aware of certain nuances of her reproductive system. Normally, the cervix should be:

35-45 millimeters at 24-28 weeks;
30-35 millimeters later than 28 weeks.

A deviation in the size of the cervix at the appropriate time should raise suspicion and a thorough medical supervision. If the doctor, using a gynecological speculum, recognizes the diagnosis of ICI, then the patient is sent to ultrasound examination. Signs of ICI during pregnancy by ultrasound can be detected using a vaginal sensor. First of all, the uzist pays attention to the following factors:

cervical length;
presence of opening of the internal pharynx.

In the presence of ICI, ultrasound can clearly see the V-shaped appearance of the cervix. It takes this form due to the opening of the internal pharynx and the closed state of the external one.

Isthmic-cervical insufficiency during pregnancy: treatment

Management of pregnancy with isthmic-cervical insufficiency should be very scrupulous because there is always a risk of premature birth or miscarriage.

Once ICI is diagnosed during pregnancy, treatment should begin immediately. First of all, the woman is checked for hormonal imbalances. Hormonal imbalances cause functional ICI and require appropriate therapy. Reception hormonal drugs lasts for 1.5-2 weeks, then the woman is sent for re-examination. If the process of opening the cervix has stopped, then the expectant mother is prescribed to take the previously prescribed drug until the end of pregnancy. If the situation does not stabilize, the doctor prescribes another type of treatment.

One of the mandatory medications is Utrozhestan for ICN during pregnancy. It is prescribed in the form of vaginal suppositories.

The next treatment option for ICI during pregnancy is the installation of an unloading pessary or the so-called gynecological ring. This device is a plastic structure that supports the cervix, redistributing the weight of the fetus and amniotic fluid. A pessary can be installed at any stage of pregnancy when there is a risk of premature birth. If ICI is progressive, then the pessary is in an auxiliary way treatments other than medications. Also, it is worth noting that installing a pessary requires constant medical supervision, taking medications that stabilize the vaginal microflora and systematically taking smears. This vaginal ring may remain in the vagina up to 37 weeks, then it is removed and labor begins.

In case of severe ICI, a woman may also have sutures placed on the internal os of the uterus. In this case, non-absorbable threads are used, most often silk.

Suturing is considered a serious measure, because if the tone of the uterus increases, this type of treatment can affect harmful consequences. That is why, if there are sutures on the internal os of the uterus, doctors prescribe drugs that reduce tone of this body. Among them:

ginipral;
papaverine;
magnesia, etc.

Pregnancy is already the strongest exercise stress for the female body. Pregnancy in the presence of isthmic-cerebral insufficiency is a completely difficult ordeal. That is why, in order to facilitate the course of pregnancy with ICI, several regimen recommendations have been developed. They include:

refusal of physical activity;
exclusion of sexual contacts;
constant rest in a supine position;
systematic use of prescribed medications;
positive psychological attitude;
routine medical examinations.

Childbirth with ICN

ICI is the inability of the sphincter ring to remain closed. That is why childbirth with ICI occurs rapidly, compared to normal labor activity. Nevertheless, correct treatment keeps the cervix from opening and, in most cases, helps a woman bear a fetus. At the time of the scheduled birth expectant mother they are admitted to the hospital, the prescribed treatment is removed, the sutures or pessary are removed and delivery is carried out naturally.

Isthmic-cervical insufficiency during pregnancy. Video

Isthmicocervical insufficiency (ICI) is a pathological condition characterized by insufficiency of the isthmus and cervix, leading to spontaneous abortion in the second and third trimesters of pregnancy. In other words, this is a condition of the cervix during pregnancy in which it begins to thin out, becoming soft, shortening and opening, losing the ability to hold the fetus in the uterus for up to 36 weeks. ICN is common cause miscarriage between 16 and 36 weeks.

In accordance with reasons for ICN are divided into:

– organic ICN– as a result of previous injuries to the cervix during childbirth (ruptures), curettage (during abortion/miscarriage or for diagnosing certain diseases), during the treatment of diseases, for example, erosion or polyp of the cervix using the method of conization (excision of part of the cervix) or diathermocoagulation (cauterization). As a result of injury, normal muscle tissue in the cervix is replaced by scar tissue, which is less elastic and more rigid (harder, stiffer, inelastic). As a result of this, the cervix loses the ability to both contract and stretch and, accordingly, cannot fully contract and retain the contents of the uterus inside.

– functional ICN, which develops for two reasons: due to a violation of the normal ratio of connective and muscle tissues in the cervix or a violation of its susceptibility to hormonal regulation. As a result of these changes, the cervix becomes too soft and pliable during pregnancy and dilates as pressure from the growing fetus increases. Functional ICI may occur in women with ovarian dysfunction or may be congenital. Unfortunately, the mechanism of development of this type of ICI has not yet been sufficiently studied. It is believed that in each individual case it is individual and there is a combination of several factors.

In both cases, the cervix is not able to resist the pressure of the growing fetus from inside the uterus, which leads to its dilatation. The fruit descends into lower section uterus, the fetal bladder protrudes into the cervical canal (prolapses), which is often accompanied by infection of the membranes and the fetus itself. Sometimes, as a result of infection, amniotic fluid leaks.

The fetus falls lower and puts even more pressure on the cervix, which opens more and more, which ultimately leads to late miscarriage (from 13 to 20 weeks of pregnancy) or premature birth(from 20 to 36 weeks of pregnancy).

There are no clinical manifestations of ICI during or outside of pregnancy. The consequence of ICI in the second and third trimesters is spontaneous termination of pregnancy, which is often accompanied by premature rupture of amniotic fluid.

Outside of pregnancy, isthmicocervical insufficiency does not threaten anything.

The only reliable method of diagnosis is vaginal examination and examination of the cervix in speculums. Vaginal examination reveals following signs(individually or in combination with each other): shortening of the neck, in severe cases - sharp, softening and thinning; the external pharynx can be either closed (more often in primigravidas) or gaping; the cervical (cervical) canal may be closed or allow the tip of a finger, one finger or two to pass through, sometimes with separation. When examined in the speculum, a gaping of the external os of the cervix with a prolapsed (protruding) amniotic sac may be detected.

Sometimes with questionable data vaginal examination on early stages development, ultrasound helps to diagnose ICI, which can detect expansion of the internal pharynx.

The most severe complication is termination of pregnancy different terms, which can begin with or without rupture of amniotic fluid. ICI is often accompanied by infection of the fetus due to the lack of a barrier to pathogenic microorganisms in the form of a closed cervix and cervical mucus, which normally protects the uterine cavity and its contents from bacteria.

Treatment methods are divided into operative and non-operative/conservative.

The surgical method involves placing sutures on the cervix to narrow it, and is carried out only in a hospital. Exist various techniques sutures, their effectiveness is almost the same. Before treatment, an ultrasound of the fetus is performed, its intrauterine condition, the location of the placenta, and the condition of the internal os are assessed. From laboratory tests A smear analysis of the flora must be prescribed and, if inflammatory changes are detected in it, treatment is carried out. The operation is performed under local anesthesia, after the operation, the patient is prescribed antispasmodic and painkillers for prophylactic purposes for several days.

After 2-3 days, the consistency of the sutures is assessed and if their condition is favorable, the patient is discharged under medical supervision antenatal clinic. Complications of the procedure may include: increased uterine tone, prenatal rupture of amniotic fluid, infection of sutures and intrauterine infection of the fetus.

If there is no effect and ICI progresses, it is not recommended to prolong pregnancy, since the sutures can cut through, causing bleeding.

Contraindications for suturing the uterus are:

– a history of pregnancy terminations in the second and third trimesters (recurrent miscarriage);

– heavy accompanying illnesses, which are a contraindication for prolonging pregnancy (severe cardiovascular diseases, impaired renal and/or liver function, some mental illness, severe gestosis of the second half of pregnancy - nephropathy of II and III degrees, eclampsia and preeclampsia);

– increased uterine tone that cannot be controlled drug treatment;

– progression of ICI – rapid shortening, softening of the cervix, opening of the internal pharynx.

The non-operative method consists of narrowing the cervix and preventing it from opening by installing a pessary. A pessary is a ring made of latex or rubber that is “put on” the cervix so that its edges rest against the walls of the vagina, holding the ring in place. This method treatment can only be used in cases where the cervical canal is closed, i.e. early stages ICN or if it is suspected, and can also be an addition to suturing.

Every 2-3 days, the pessary is removed, disinfected and reinstalled. The method is less effective than the first, but has several advantages: bloodlessness, ease of implementation and no need for hospital treatment.

The prognosis depends on the stage and form of ICI, on the presence of concomitant infectious diseases and from the duration of pregnancy. The shorter the pregnancy and the more open the cervix, the worse the prognosis. As a rule, when early diagnosis Pregnancy can be prolonged in 2/3 of all patients.

It consists of careful curettage, examination and suturing of cervical ruptures after childbirth, cervical plastic surgery when old ruptures are detected outside of pregnancy, and treatment of hormonal disorders.

Obstetrician-gynecologist Kondrashova D.V.

P.S. And now I am already 39 years old. And I’m 9 weeks pregnant and we really hope for a son.

It is important to know! Scientists in Israel have already found a way to dissolve cholesterol plaques V blood vessels special organic matter AL Protector B.V., which stands out from the butterfly.

copy; 2018 Causes, symptoms and treatment. Medical Magazine