1.5 cm opening of the cervix. Raspberry leaf for cervical dilatation

By having an understanding of what happens during each stage of the process, a woman will be able to cope more easily with labor and be an active participant in it.

We will try to give a consistent description of what physiological processes occur during childbirth, what a woman feels at this time, and what medical procedures can be carried out during different periods of labor.

Childbirth is the process of expulsion of the fetus from the uterine cavity, its immediate birth and the release of the placenta and membranes. There are three periods of labor: the period of opening, the period of expulsion and the afterbirth period.

Cervical dilatation

During this period, a gradual expansion of the cervical canal occurs, that is, the opening of the cervix. As a result, an opening of sufficient diameter is formed through which the fetus can penetrate from the uterine cavity into the birth canal formed by the bones and soft tissues of the pelvis.

The opening of the cervix occurs due to the fact that the uterus begins to contract, and due to these contractions the lower part of the uterus, i.e. its lower segment stretches and becomes thinner. Dilation is conventionally measured in centimeters and determined during a special obstetric vaginal examination. As the degree of dilatation of the cervix increases, muscle contractions intensify, become longer and more frequent. These contractions are contractions - painful sensations in the lower abdomen or lumbar region that the woman in labor feels.

The first stage of labor begins with the appearance of regular contractions, which gradually become more intense, frequent and prolonged. Typically, the cervix begins to dilate with the onset of contractions that last 15–20 seconds and are spaced 15–20 minutes apart.

During the first stage of labor, there are two phases - latent and active.

Latent phase continues until approximately 4–5 cm of dilation; during this phase, labor is not intense enough, contractions are not painful.

Active phase the first stage of labor begins after 5 cm of dilation and continues until full dilation, that is, up to 10 cm. At this stage, contractions become frequent, and pain -
more intense and pronounced.

In addition to uterine contractions, an important part of the first stage of labor is the release of amniotic fluid. The time of release of water in relation to the degree of dilatation of the cervix is ​​of great importance, as this can affect the course of the labor process.

Normally, amniotic fluid is released during the active phase of labor, since due to intense uterine contractions, the pressure on the amniotic sac increases and it opens. Typically, after opening the amniotic sac, labor intensifies and contractions become more frequent and painful.
When the amniotic fluid ruptures before the cervix is ​​dilated by 5 cm, they speak of early rupture. It is most favorable if the outpouring of water occurs after the dilation has reached 5 cm. The fact is that at the beginning of labor, before the cervix is ​​dilated by 5 cm, there is an increased risk of developing weakness of labor, that is, a weakening of contractions or their complete cessation. As a result, the course of labor slows down and may drag on indefinitely. If the amniotic fluid has already poured out, then the fetus is not isolated and not protected by the amniotic sac and amniotic fluid. In this case, the risk of developing intrauterine infection increases. To avoid intrauterine infection, labor should be completed within 12–14 hours from the moment of rupture of amniotic fluid.

If the waters break before regular labor begins and the cervix begins to dilate, they speak of premature rupture of water.

How to behave

If you experience regular painful or pulling sensations in your lower abdomen, begin to note the start and end times of these sensations, as well as their duration. If they do not stop within 1–2 hours, last approximately 15 seconds every 20 minutes and gradually intensify, this indicates that the cervix has begun to gradually open, that is, the first stage of labor has begun and you can get ready for the maternity hospital. At the same time, there is no need to rush - you can observe your condition for 2-3 hours and go to the maternity hospital with more or less intense labor, that is, with contractions every 7-10 minutes.

If your amniotic fluid has broken, then it is better not to delay the trip to the maternity hospital, regardless of whether contractions appear or not, since premature or early rupture of amniotic fluid can affect the choice of labor management tactics.

In addition, remember the time when regular contractions began, and also record when the amniotic fluid was released. Place a clean diaper between your legs so that the emergency room doctor can assess the amount of water and their nature, which can be used to indirectly assess the condition of the unborn baby. If the waters have a greenish tint, this means that original feces - meconium - have entered the amniotic fluid. This may indicate fetal hypoxia, that is, that the baby is experiencing a lack of oxygen. If the waters have a yellowish tint, this may indirectly indicate a Rh conflict. Therefore, even if the water leaks just a little or, on the contrary, pours out in large quantities, you should save the diaper or cotton pad with the leaked amniotic fluid.

To relieve pain during uterine contractions, try to take deep breaths through your nose and exhale slowly through your mouth during contractions. During contractions, you should behave actively, try not to lie down, but, on the contrary, move more, walk around the ward.

During a contraction, try different positions that make the pain easier to bear, such as resting your hands on the bed and leaning slightly forward with your feet shoulder-width apart. If your husband is present at the birth, you can lean on him or squat down, and ask your husband to support you.

A fitball, a special large inflatable ball, will help ease the sensations during contractions.

If possible, contractions can be endured in the shower, directing a warm stream of water to the stomach, or immerse yourself in a warm bath.

What does a doctor do?

During the first stage of labor, special obstetric manipulations are required from time to time to help choose the right tactics for labor and assess the risk of possible complications.

An external obstetric examination is performed upon admission of the expectant mother to the maternity hospital. During this procedure, the approximate weight of the fetus is assessed, the external dimensions of the expectant mother's pelvis are measured, the location of the fetus, the standing height of the presenting part are determined, that is, at what level in the birth canal is the presenting part of the fetus - the head or buttocks.

During a vaginal examination, the condition of the cervix, the degree of its dilatation, and the integrity of the amniotic sac are assessed. The presenting part is determined: the head, legs or buttocks of the fetus - and the nature of its insertion, that is, which part - the back of the head, forehead or face - the head was inserted into the small pelvis. The nature of the amniotic fluid, its color and quantity are also assessed.

During the normal course of the first stage of labor, a vaginal examination is performed every 4 hours to assess the dynamics of cervical dilatation. If complications occur, this study may need to be performed more frequently.

Every hour during the dilatation period, the mother's blood pressure is measured and auscultation is performed - listening to the fetal heartbeat. It is performed before contraction, during contraction and after it - this is necessary in order to assess how the unborn baby reacts to uterine contractions.

To more accurately assess the nature of the fetal heartbeat and indirectly study its condition during childbirth, each woman in labor undergoes a cardiotocographic study - CTG. Two sensors are installed on the surface of the uterus, one of them records the fetal heart rate, and the other - the frequency and intensity of uterine contractions.

The result is two parallel curves, after studying which the obstetrician-gynecologist can objectively assess the well-being of the unborn baby, notice signs of possible complications in time and take measures to prevent them. During normal labor, CTG is performed once and lasts for 20–30 minutes. If necessary, this study is performed more often; Sometimes, when the birth is high-risk, a continuous recording of a cardiotocogram is performed. This happens, for example, if there is a postoperative scar on the uterus or with gestosis - a complication of pregnancy, which is manifested by high blood pressure, swelling and the appearance of protein in the urine.

Period of expulsion of the fetus

After the cervix has fully dilated, the second stage of labor begins, that is, the expulsion of the fetus from the uterine cavity, its passage through the birth canal and, ultimately, its birth. This period lasts for primiparous women from 40 minutes to 2 hours, and for multiparous women it can end in 15–30 minutes.

After leaving the uterine cavity, the presenting part of the fetus, most often the head, performing certain rotational movements with its smallest size, gradually descends to the pelvic floor with each contraction and emerges from the genital slit. After this, the birth of the head occurs, then the shoulders, and finally the baby is born entirely.

During the expulsion period, uterine contractions are called pushing. This is due to the fact that, descending to the pelvic floor, the fetus exerts significant pressure on nearby organs, including the rectum, as a result of which the woman has an involuntary strong desire to push.

How to behave?

The second stage of labor requires a lot of energy expenditure from both the expectant mother and the fetus, as well as the well-coordinated work of the woman in labor and the obstetrics-gynecology team. Therefore, in order to make the course of this period as easy as possible and avoid various complications, you should listen carefully to what the doctor or midwife says and try to follow their advice exactly.

During the second stage of labor, obstetric tactics are largely determined by the level at which the presenting part of the fetus is located. Depending on this, you may be advised to push as hard as you can, or, conversely, try to hold back.

The desire to push may be accompanied by unpleasant pain. However, if pushing is not recommended at this time, every effort should be made to restrain the pushing, as otherwise cervical rupture may occur. The doctor may ask you to “breathe” through the pushing. In this case, you need to take frequent sharp breaths and exhales through your mouth - this is called breathing “doggy”. This breathing technique will help you control the urge to push.

If you are already in the delivery chair and your baby is about to be born, you will be asked to push as hard as possible while pushing. At this moment, you should concentrate as much as possible on what the midwife says, since she sees what stage the fetus is at and knows what needs to be done to facilitate its birth.

When you start pushing, you should take a deep breath and start pushing, trying to push the baby out. Typically, you may be asked to push 2-3 times during one push. Try not to scream or release air under any circumstances, as this will only weaken the push and it will be ineffective. Between attempts you should lie quietly, try to even out your breathing and rest before the next attempt. When the fetal head erupts, i.e. is established in the genital slit, the midwife may ask you not to push again, since the force of uterine contraction is already sufficient for further advancement of the head and its removal as carefully as possible.

What does a doctor do?

During the expulsion period, the mother and fetus are exposed to maximum stress. Therefore, monitoring the condition of both mother and baby is carried out throughout the entire second stage of labor.

The mother's blood pressure is measured every half hour. Listening to the fetal heartbeat is carried out with each push, both during uterine contractions and after it, to assess how the baby reacts to the push.

External obstetric examination is also regularly performed to determine where the presenting part is located. If necessary, a vaginal examination is performed.

When the head erupts, it is possible to perform an episiotomy - a surgical dissection of the perineum, which is used to shorten and facilitate the birth of the head. When giving birth in a breech position, an episiotomy is mandatory. The decision to use an episiotomy is made in cases where there is a threat of perineal rupture. After all, an incision made by a surgical instrument is easier to stitch up, and it heals faster than a lacerated wound with crushed edges due to a spontaneous rupture of the perineum. In addition, an episiotomy is performed when the condition of the fetus worsens in order to speed up its birth and, if necessary, immediately carry out resuscitation measures.

After birth, the baby is placed on the mother's stomach to provide first skin-to-skin contact. The doctor evaluates the condition of the newborn using special criteria - the Apgar scale. In this case, indicators such as heartbeat, breathing, skin color, reflexes and muscle tone of the newborn at 1 and 5 minutes after birth are assessed on a ten-point scale.

Succession period

During the third stage of labor, the placenta, the remainder of the umbilical cord, and the membranes are separated and released. This should happen within 30–40 minutes after the baby is born. In order for the placenta to separate, weak uterine contractions appear after childbirth, due to which the placenta gradually separates from the wall of the uterus. Once separated, the placenta is born; from this moment it is considered that childbirth is over and the postpartum period begins.

How to behave and what does the doctor do?

This period is the shortest and most painless, and practically no effort is required from the postpartum woman. The midwife monitors whether the placenta has separated. To do this, she may ask you to push slightly. If the remainder of the umbilical cord is retracted back into the vagina, then the placenta has not yet separated from the placental site. And if the umbilical cord remains in the same position, the placenta has separated. The midwife will again ask you to push and gently pull the umbilical cord to bring the placenta out.

After this, a thorough examination of the placenta and fetal membranes is performed. If there is any suspicion or indication that part of the placenta or membranes remains in the uterine cavity, a manual examination of the uterine cavity should be performed to remove any remaining parts of the placenta. This is necessary to prevent the development of postpartum hemorrhage and infection. Under intravenous anesthesia, the doctor inserts his hand into the uterine cavity, carefully examines its walls from the inside and, if retained lobes of the placenta or membranes are detected, removes them out. If spontaneous separation of the placenta does not occur within 30–40 minutes, this manipulation is performed manually under intravenous anesthesia.

After childbirth

After the birth of the placenta, a thorough examination of the soft tissues of the birth canal and perineum is performed. If ruptures of the cervix or vagina are detected, they are sutured, as well as surgical restoration of the perineum if an episiotomy has been performed or ruptures have occurred.

Surgical correction is performed under local anesthesia; in case of significant damage, intravenous anesthesia may be required. Urine is released through a catheter so that the postpartum woman does not have to worry about a full bladder for the next few hours. Then, in order to prevent postpartum bleeding, women place a special bag of ice on the lower abdomen, which remains there for 30–40 minutes.

While doctors examine the mother, the midwife and pediatrician perform the first toilet of the newborn, measure his height and weight, head and chest circumference, and treat the umbilical wound.

Then the baby is placed on the mother's breast, and for 2 hours after birth they remain in the maternity ward, where doctors monitor the woman's condition. Blood pressure and pulse are monitored, uterine contractions and the nature of vaginal bleeding are assessed. This is necessary so that if postpartum hemorrhage occurs, the necessary full assistance can be provided in a timely manner.

If the condition of the mother and the newborn is satisfactory, 2 hours after birth they are transferred to the postpartum ward.

Just before childbirth, the cervix changes dramatically. A pregnant woman does not feel these changes, but the unborn child gets a chance to be born naturally. So how exactly does this reproductive organ change and when is medical attention needed to improve the dilatation of the uterus? We are looking for answers to these and other similar questions.

Ideal cervix before childbirth

The parameters characterizing the state of the uterus before childbirth are its location in the pelvis, state of softness and length. The softening of the cervix to the point where it can allow 1-2 fingers of the doctor inside indicates the readiness of the birth canal for the process of delivery. Such changes are accompanied by the release of the mucus plug. That is, the sooner the cervix begins to dilate, the sooner the woman in labor notices this sign of the onset of contractions.

Before childbirth, the cervix shortens. According to medical statistics, its length is about one centimeter. If we talk about the location, then it becomes in the center of the small pelvis, while during pregnancy the cervix is ​​tilted back.

Doctors evaluate all of the above parameters on a five-point scale. A score of 5 indicates that the uterus is ideally ready for childbirth. This condition is called a mature uterus.

Ways to stimulate cervical dilatation

The above are excellent prenatal parameters. But in practice, this does not always happen, and doctors resort to stimulating the process of cervical dilatation.

If a medical examination shows that the cervix is ​​not mature, and you are due to give birth soon, then it is quite acceptable to perform this process and stimulation. Not using it sometimes means dooming the child, given the fact that before birth the placenta “grows old” and cannot cope with its functions as before.

In practice, stimulation is done in four ways, sometimes with a combination of them:

1. Sinestrol injections intramuscularly. The drug makes the cervix mature, but does not affect contractions.
2. Insertion of kelp sticks into the cervix. Such sticks, 5 cm long, are placed in. After a few hours, they swell under the influence of moisture and thus open the cervical canal.
3. Injection of a gel with prostaglandins into the cervical canal. This gel works quickly - and the neck opens in 2-3 hours.
4. Administration of Enzaprost intravenously. This drug also contains prostaglandins. Thus, the period of contractions is reduced in time.

Sometimes women use self-induction of labor.

Among them:

1. Enema. After it, the mucus plug comes off - and the cervix becomes mature. The procedure can only be used by women who have already reached their due date, that is, the baby is full-term.
2. A warm bath is not recommended for loose plugs and waters. The procedure is also dangerous for women with high blood pressure.
3. Sex acts as a medical stimulant, because sperm contains prostaglandins. That is, it promotes the maturity of the uterus. But pregnant women whose plug has already come out should not have sex. After all, there is a possibility of “catching” an infection in the uterus.
4. Physical activity. This could be a brisk walk, washing the floors, or cleaning. Women with hypertension do not need to overdo these methods.

But such methods can be fraught with dangerous consequences.

Stages of cervical dilatation

The cervix goes through several stages of dilatation before childbirth. The first is called latent or slow. It lasts 4-6 hours with a dilatation of up to 4 cm. In this case, contractions occur every 6-7 minutes.

The second stage is called active or fast. Every hour the cervix dilates by 1 cm. This continues up to 10 cm, and contractions occur every minute.

The third stage is full disclosure. It characterizes the process of the onset of labor. Sometimes the dilation of the cervix is ​​premature. This is evidence of pathology and, without treatment, can cause premature birth or miscarriage.

A pregnant woman should remember that in the period before childbirth she needs to be prepared for the fact that labor will begin earlier. If you feel unwell or have other symptoms, consult a doctor immediately.

Peace of mind and health to you!

Especially for Elena TOLOCHIK

Well, in a nutshell it was like this...
This is my 4th pregnancy. 1 B in 2006 daughter Stefania 3550 g and 55 cm. 2 B in 2011 daughter Diana 3350 g and 53 cm. 3 B alas anembryony in 2016 at 12 weeks I recognized on 1 screen. 4 B current. She came on her 4th cycle after cleaning.
In general, she walked more or less: she lay down once at 25 weeks for preservation, apparently tired from work; mild anemia and low placentation on the 2nd screen 41 mm, on ultrasound at 36 weeks 55 mm.
The deadline was monthly from 08/05/16 to 05/12/2017.
05/06/2017 we went to my husband’s sister’s anniversary and ate our fill of rolls and all sorts of other goodies. We laughed heartily while watching jokes about carousels on YouTube. We arrived home, and I still had steamed raspberry leaves from the morning. I decided to prepare my neck this way, because with 2B I had to put gel on it twice to get it ready. 3 weeks before, my stomach dropped. I started writing endlessly. And also this intestinal cleansing 4 times a day.
I wanted to drink raspberries before my birthday, but I forgot. I drank at 12 am and went to bed. By the way, I barely found it in the city and drank it about 4 times this week, 1 tbsp per day, cold. On Thursday 04.05 I already went to the perinatal center, they even left me there to spend the night. They were afraid to let go. But nothing moved, and on Friday I left them with an ultrasound report about pvp at 3300 degrees, overjoyed.
And so on..
I woke up at 3 am exactly from cramping, very tolerable pain. I waited 1.5 hours, timing the interval and taking into account the intensity. Making sure that these are not sweatpants. I wake up my husband and tell him: we’ll drink tea and bagels and let’s go. He told me: Exactly? And I told him: if these are not contractions, then I am Carlo’s dad. Something like this. We arrived at the RD at the beginning of 6. Docks, enema, examination 3 cm... the bubble says until I open it. Let's give birth like this.
I still think: Well, you know better. My husband and I have had partner births 3 times already. He changed clothes, waited for me and we went to the birth block.
During labor there were contractions every 2 minutes, 30 seconds each, which were approximately tolerable. I was still wondering to myself, is that all? Time 8 contractions got stronger. I started moaning. I've already had a CTG 2 times for 1 hour and they're recording. I really wanted to write. They said be patient or we’ll give you a duck. I say: come on. So I couldn't pee on the duck. I waited until the end of the CTG and went to write.
The doctor came at 9 to look at me and seemed to immediately open the bladder. Young uncle doctor. I looked for a long time for something to hook on and pierced it. Dilation says 4-5 cm!!! I was shocked and the midwives didn’t expect it either. Everyone thought I was about to give birth.
It turns out... during these 55 minutes... I went to the toilet once to pee and wait there for 2 contractions. So at 2 I was tense and shouted to the girls. And the midwife brought me to the room and said: get on the bed, I’ll take a look. Somehow, after 2 more contractions at the bed, I climbed onto it. Everyone says: We are giving birth. Everyone here was fussing. The pushing period was 10 minutes.
Those. from 9 am to 9.45 I dilated from 4-5 cm to 10 cm!!!
I don’t remember with what effort I gave birth to my head. But someone from the crowd suggested cutting me. The midwife didn't give it. Thanks to her for this! Like this. I warned her about the delicate problem of my 5th point. And she already told me she covered everything up. Well done! Actually gold, not a midwife. Her name is Lyudmila Sergeevna. Young girl. I was distracted the whole way. She asked about the children, their names, my husband and I’s ages. By the way, I am 31, and my husband is 05/08. That is, the day after giving birth, he is 34 years old. She said that if you still want a boy, then according to statistics this is the 5th child. That is, you need to come to them 2 more times. After I gave birth, she went and warmed up some porridge for me, which was brought to the birth room for breakfast at 8 am. She helped me a lot. This is what Psycho-prevention during childbirth means.
Breathing has helped me a lot for 3 births. Inhaling through your nose, exhale for a long time through your mouth, as if blowing out a candle. Very!

She received me on one shift, and gave birth during that shift.
It turns out that all the births took place from 3 am to 9.55. The last 2 hours were the worst in terms of pain. I don’t know how it would have gone if my bladder had been opened right away... but that’s exactly how it was. So that's how it should be.
Result: our third daughter Taisiya was born on 05/07/2017 at 9.55 with a weight of 3840 grams and a height of 54 cm. So you lost 540 grams with an ultrasound.
I don’t know the volume of the head and chest yet, but I think they are not small.
This labor was the fastest and only hurt the last 2 hours. I don’t know how to anyone. Either slowly and painfully, or quickly and a little more painfully.
I wish everyone to have as much happiness as my husband and I and our large, now large family have. Our daughters Stephanie are 11 years old, Diana is 5 years old and our youngest is 1 day old today.

The successful outcome of a normal birth depends on the functioning of the cervix, which in turn depends on the level of hormones in the blood of the mother. Throughout pregnancy, changes occur in the cervix, but before the onset of labor, it must be tightly closed, otherwise the pregnancy may be terminated prematurely.

Cervix before childbirth

Before childbirth, under the influence of prostaglandin hormones, processes called ripening occur in the cervix. There is a certain scale that allows you to evaluate the cervix before childbirth, and 3 criteria are assessed: consistency, length of the cervix, patency of the cervical canal and its location to the pelvic axis. Each criterion is scored during a cervical examination from 0 to 2 points:

• a score of 0-2 points corresponds to an immature cervix before birth;
• a score of 3-4 points corresponds to an insufficiently mature cervix;
• score 5-6 points – mature cervix.

During a normal pregnancy, the cervix should ripen by 38-39 weeks. Under the influence of hormones, the cervix softens before childbirth, its centering in relation to the wire axis of the pelvis. The length of the cervix before birth is reduced to 10-15 mm and the external pharynx opens by 1-2 cm, that is, it becomes passable for 1 finger of the obstetrician.

Dilatation of the cervix before childbirth

The opening of the cervix before childbirth occurs gradually and reaches 10 cm (the cervical canal must allow 5 fingers of the obstetrician to pass through). Dilation of the cervix during labor is divided into 2 phases: latent (dilation up to 4 cm) and active (from 4 cm to 10 cm). The latent phase in primiparous women lasts 6-9 hours, in multiparous women 3-5 hours. From the moment the active phase begins, the rate of opening of the cervix becomes 1 cm per hour. The soft cervix easily opens under the influence of pressure from the fetal head and wedging of the lower pole of the fetal bladder into its canal.

How to help dilate the cervix?

Currently, few modern women can boast of excellent health. An accelerated pace of life, frequent stress, poor nutrition and poor ecology can disrupt the production of prostaglandins in the female body, on which the processes of cervical ripening and opening directly depend. In order to accelerate the ripening of the cervix and its opening during childbirth, therapeutic drugs based on prostaglandins have been developed. A synthetic analogue of prostaglandin E1 (Cytotec) or an analogue of prostaglandin E2 in gel form (Prepidil) promotes cervical ripening within a few hours. But they are used very rarely due to their high cost. Narcotic and non-narcotic analgesics (promedol, fentanyl, nalbuphine) can be used during childbirth, but they can cause respiratory depression in the fetus after birth and necessitate the administration of an antidote. An effective and relatively safe method for dilating the cervix is ​​epidural anesthesia. It is performed by an anesthesiologist under sterile conditions. It does not have a negative effect on the fetus, since the administered drugs do not enter the bloodstream, and not only accelerates the dilatation of the cervix, but also makes this process painless.

Cervical rupture

The better the cervix matures before childbirth, the less likely it is to rupture during the birth of the child. Also the cause of the breakup there may be a large fetus, rapid labor, incorrect insertion of the fetus and the use of obstetric forceps or vacuum extraction of the fetus. A cervical rupture may be accompanied by heavy bleeding, since the cervix is ​​well supplied with blood. In case of ruptures, the cervix is ​​sutured using absorbable threads; the woman does not feel these stitches, so healing is painless.

Thus, cervical ripening is disrupted for reasons that depend and do not depend on the woman herself. Therefore, a woman herself can help prepare her body for childbirth by following a daily routine, eating right and not thinking about troubles.

Normal and timely labor never begins suddenly and violently. On the eve of childbirth, a woman experiences their precursors, and the uterus and its cervix are prepared for the birth process. In particular, the cervix begins to “ripen” and expand, that is, it enters the stage of opening of the uterine pharynx. Childbirth is a complex and lengthy process and largely depends on the interaction of the uterus, cervix and hormonal levels, which determines its successful completion.

The cervix is...

The lower part of the uterus is called its cervix, which looks like a narrow cylinder and connects the uterine cavity to the vagina. Directly in the cervix, the vaginal part is distinguished - the visible part, which protrudes into the vagina below its fornix. There is also a supravaginal part - the upper part located above the arches. The cervical (cervical) canal passes through the cervix, its upper end is called the internal os, and the lower end is called the external os. During pregnancy, there is a mucus plug in the cervical canal, the function of which is to prevent infection from entering the uterine cavity from the vagina.

The uterus is a female reproductive organ, the main purpose of which is to bear a fetus (fetal receptacle). The uterus consists of 3 layers: the inner one is represented by the endometrium, the middle one is muscle tissue and the outer one is the serosa. The bulk of the uterus is the muscular layer, which hypertrophies and grows during gestation. The myometrium of the uterus has a contractile function, due to which contractions occur, the cervix (uterine os) opens and the fetus is expelled from the uterine cavity during labor.

Periods of labor

The labor process lasts quite a long time, and normally in primiparous women it lasts 10–12 hours, while in multiparous women it lasts approximately 6–8 hours. Childbirth itself includes three periods:

• I period – the period of contractions (opening of the uterine pharynx);
• The second period is called the period of pushing (the period of expulsion of the fetus);
• The third period is the period of separation and discharge of the child's place (placeholder), therefore it is called the afterbirth period.

The longest stage of labor is the period of opening of the uterine pharynx. It is caused by uterine contractions, during which the amniotic sac is formed, the fetal head moves along the pelvic ring and cervical dilatation is ensured.

Period of contractions

First, contractions arise and become established - no more than 2 in 10 minutes. Moreover, the duration of uterine contraction reaches 30–40 seconds, and uterine relaxation reaches 80–120 seconds. Long-term relaxation of the uterine muscles after each contraction ensures the transition of the cervical tissues into the structure of the lower segment of the uterus, as a result of which the length of the visible part of the cervix decreases (it shortens), and the lower uterine segment itself stretches and lengthens.

As a result of the ongoing processes, the presenting part of the fetus (usually the head) is fixed at the entrance to the pelvis, separating the amniotic fluid, and as a result, anterior and posterior waters are formed. A fetal bladder is formed (contains anterior waters), which acts like a hydraulic wedge, wedges into the internal os, opening it.

In first-time mothers, the latent phase of dilatation is always longer than in women giving birth for the second time, which determines the longer total duration of labor. The completion of the latent phase is marked by complete or almost complete effacement of the cervix.

The active phase begins with 4 cm of cervical dilation and continues up to 8 cm. At the same time, contractions become more frequent and their number reaches 3 - 5 in 10 minutes, periods of contraction and relaxation of the uterus are equalized and amount to 60 - 90 seconds. The active phase lasts for primiparous and multiparous women for 3–4 hours. It is during the active phase that labor becomes intense, and the cervix dilates quickly. The fetal head moves along the birth canal, the cervix has completely moved into the lower uterine segment (merged with it), and by the end of the active phase the opening of the uterine pharynx is complete or almost complete (within 8 - 10 cm).

At the end of the active phase, the amniotic sac is opened and the water is released. If the cervical opening has reached 8 - 10 cm and the waters have broken, this is called timely rupture of water, the release of water when the opening is up to 7 cm is called early, with 10 or more cm of opening of the pharynx, amniotomy is indicated (the procedure for opening the amniotic sac), which is called delayed rupture of water.

Terminology

Dilatation of the cervix does not have any symptoms; only a doctor can determine it by conducting a vaginal examination.

To understand how the process of softening, shortening and smoothing of the cervix progresses, you should define obstetric terms. In the recent past, obstetricians determined the opening of the uterine pharynx in the fingers. Roughly speaking, how many fingers the uterine os allows through, so is the opening. On average, the width of the “obstetric finger” is 2 cm, but, as you know, everyone’s fingers are different, so measuring the opening in cm is considered more accurate. So:

• if the cervix is ​​dilated by 1 finger, then they speak of an opening of 2 - 3 cm;
• if the opening of the uterine pharynx has reached 3–4 cm, this is equivalent to the dilation of the cervix by 2 fingers, which, as a rule, is diagnosed already at the beginning of regular labor (at least 3 contractions in 10 minutes);
• almost complete opening is indicated by the opening of the cervix by 8 cm or 4 fingers;
• full dilatation is recorded when the cervix is ​​completely smoothed (thin edges) and is passable for 5 fingers or 10 cm (the head descends to the pelvic floor, turning with an arrow-shaped suture to a straight size, an irresistible desire to push appears - it’s time to go to the delivery room for the birth of the baby - the beginning of the second period childbirth).

How does the cervix ripen?

The appearing harbingers of labor indicate the imminent onset of labor (approximately from 2 weeks to 2 hours):

• the fundus of the uterus descends (for 2 - 3 weeks before the onset of contractions), which is explained by the pressing of the presenting part of the fetus to the pelvis, a woman feels this sign by easier breathing;
• the pressed head of the fetus puts pressure on the pelvic organs (bladder, intestines), which leads to increased urination and constipation;
• increased excitability of the uterus (the uterus “turns to stone” when the fetus moves, the woman moves suddenly, or when the abdomen is stroked/pinched);
• possible appearance - they are irregular and sparse, drawn-out and short;
• The cervix begins to “ripen” - it softens, allows the tip of the finger to pass through, shortens and “centers.”

Dilatation of the cervix before childbirth occurs very slowly and gradually over the course of a month, and intensifies on the last day or two before birth. In primiparous women, the opening of the cervical canal is about 2 cm, while in multiparous women the opening exceeds 2 cm.

To establish cervical maturity, a scale developed by Bishop is used, which includes assessment of the following criteria:

• consistency (density) of the neck: if it is dense - this is regarded as 0 points, if it is softened along the periphery, but the internal pharynx is dense - 1 point, soft both inside and outside - 2 points;
• length of the neck (the process of its shortening) - if it exceeds 2 cm - 0 points, the length reaches 1 - 2 cm - score 1 point, the neck is shortened and does not reach 1 cm in length - 2 points;
• patency of the cervical canal: a closed external pharynx or the tip of a finger passes through - score 0 points, the cervical canal is passed to a closed internal pharynx - this is scored as 1 point, and if the canal allows one or 2 fingers to pass beyond the internal pharynx - scored at 2 points;
• how the neck is located tangentially to the wire axis of the pelvis: directed posteriorly - 0 points, displaced anteriorly - 1 point, located in the middle or “centered” - 2 points.

When summing up the points, the maturity of the cervix is ​​assessed. An immature cervix is ​​considered with a score of 0 - 2 points, 3 - 4 points are regarded as an insufficiently mature or ripening cervix, and with 5 - 8 points they speak of a mature cervix.

Vaginal examination

To determine the degree of readiness of the cervix and not only, the doctor conducts a mandatory vaginal examination (upon admission to the maternity hospital and at 38–39 weeks at an appointment at the antenatal clinic).

If the woman is already in the maternity ward, a vaginal examination to determine the process of opening of the uterine pharynx every 4 to 6 hours or for emergency indications:

• discharge of amniotic fluid;
• carrying out a possible amniotomy (weakness of labor, or flat amniotic sac);
• with the development of anomalies of labor forces (clinically narrow pelvis, excessive labor, incoordination);
• before performing regional anesthesia (EDA, SMA) to determine the cause of painful contractions;
• the occurrence of bloody discharge from the genital tract;
• in the case of established regular labor (preliminary period, turning into contractions).

When conducting a vaginal examination, the obstetrician assesses the condition of the cervix: its degree of dilation, smoothing, thickness and extensibility of the cervical edges, as well as the presence of scars on the soft tissues of the genital tract. In addition, the capacity of the pelvis is assessed, the presenting part of the fetus and its insertion are palpated (localization of the sagittal suture on the head and fontanelles), the advancement of the presenting part, the presence of bone deformities and exostoses. The amniotic sac must be assessed (integrity, functionality).

Based on subjective signs of dilatation and vaginal examination data, a partogram of labor is compiled and maintained. Contractions are considered subjective signs of labor, in particular the opening of the uterine pharynx. The criteria for assessing contractions include their duration and frequency, severity and uterine activity (the latter is determined instrumentally). The partogram of labor allows you to visually record the dynamics of the opening of the uterine pharynx. A graph is drawn up, the horizontal length of which indicates the duration of labor in hours, and the vertical dilatation of the cervix in cm. Based on the partogram, the latent and active phases of labor can be distinguished. A steep rise in the curve indicates the effectiveness of the birth act.

If the cervix dilates prematurely

Dilation of the cervix during pregnancy, that is, long before childbirth, is called isthmic-cervical insufficiency. This pathology is characterized by the fact that both the cervix and the isthmus do not perform their main function during gestation - obturator. In this case, the cervix softens, shortens and smoothes, which does not allow keeping the fetus in the sac and leads to spontaneous abortion. Termination of pregnancy usually occurs in the 2nd – 3rd trimesters. The incompetence of the cervix is ​​indicated by the fact that it shortens to 25 mm or less at 20–30 weeks of gestation.

Isthmic-cervical insufficiency can be organic and functional. The organic form of pathology develops as a result of various cervical injuries - induced abortions (see), cervical ruptures during childbirth, surgical methods for treating cervical diseases. The functional form of the disease is caused either by hormonal imbalance or increased load on the cervix and isthmus during pregnancy (multiple pregnancy, excess water or a large fetus).

How to maintain pregnancy when the cervix is ​​dilated

But even with cervical dilatation by 1 - 2 fingers at a period of 28 weeks or more, it is quite possible to maintain the pregnancy, or at least prolong it until the birth of a completely viable fetus. In such cases, the following are prescribed:

• bed rest;
• emotional peace;
• sedatives;
• antispasmodics (magne-B6, no-spa,);
• tocolytics (ginipral, partusisten).

Treatment is mandatory aimed at producing surfactant in the fetal lungs (glucocorticoids are prescribed), which accelerates their maturation.

In addition, treatment and prevention of further premature dilatation of the cervix is ​​carried out surgically - sutures are placed on the cervix, which are removed at 37 weeks.

The cervix is ​​immature - what then?

The opposite situation is possible, when the cervix is ​​“not ready” for childbirth. That is, hour X has arrived (the expected date of birth), and even several days or weeks have passed, but no structural changes are observed in the cervix, it remains long, dense, deviated posteriorly or anteriorly, and the internal pharynx is impassable or allows the tip of the finger to pass through. What do doctors do in this case?

All methods of influencing the cervix, leading to its maturation, are divided into medicinal and non-medicinal. Medicinal methods include the introduction of special gels and suppositories with prostaglandins into the vagina or cervix. Prostaglandins are hormones that accelerate the process of cervical ripening, increase the excitability of the uterus, and during childbirth their intravenous administration is practiced in case of weakness of labor forces. Local administration of prostaglandins has no systemic effect (no side effects) and contributes to the shortening and smoothing of the cervix.

Non-medicinal methods of stimulating cervical dilatation include:

Sticks – kelp

The sticks are made from dried kelp seaweed, which are highly hygroscopic (they absorb water well). Such a number of sticks are inserted into the cervical canal so that they fill it tightly. As the sticks absorb liquid, they swell and stretch the cervix, causing it to dilate.

Foley catheter

The catheter for dilating the cervix is ​​represented by a flexible tube with a balloon attached to one end. A catheter with a balloon at the end is inserted by the doctor into the cervical canal, the balloon is filled with air and left in the cervix for 24 hours. Mechanical action on the cervix stimulates its opening, as well as the production of prostaglandins. The method is very painful and increases the risk of infection of the birth canal.

Cleansing enema

Unfortunately, some maternity hospitals have refused to perform a cleansing enema for a woman admitted to give birth, but in vain. Free intestines, as well as its peristalsis during defecation, increase the excitability of the uterus, increase its tone, and, consequently, accelerate the process of cervical dilatation.

Question - answer

How can you speed up cervical dilatation at home?

• long walks in the fresh air increase the excitability of the uterus and the production of prostaglandins, and the presenting part of the baby is fixed at the entrance to the pelvis, further stimulating the opening of the cervix;
• take care of your bladder and intestines, avoid constipation and prolonged abstinence from urination;
• eat more salads made from fresh vegetables dressed with vegetable oil;
• take a decoction of raspberry leaves;
• stimulate the nipples (when they are irritated, oxytocin is released, which causes uterine contractions).
• Are there any special exercises for opening the cervix?

At home, cervical ripening is accelerated by walking up stairs, swimming and diving, bending and turning the body. It is also recommended to take a warm bath, massage the ear and little finger, breathing exercises and exercises to strengthen the perineal muscles, and do yoga. In maternity hospitals there are special gymnastic balls, the seat and bounces on which during contractions accelerate the opening of the uterine pharynx.

Does sex really help prepare your cervix for childbirth?

Yes, having sex in the last days and weeks of pregnancy (provided the amniotic sac is intact and there is a mucus plug in the cervical canal) contributes to the ripening of the cervix. First, during orgasm, oxytocin is released, which stimulates uterine activity. And, secondly, sperm contains prostaglandins, which have a beneficial effect on the process of cervical maturation.

At what opening does pushing begin?

Pushing is a voluntary contraction of the abdominal muscles. The desire to push arises in women in labor already at 8 cm. But until the cervix is ​​fully dilated (10 cm) and the head drops to the bottom of the pelvis (that is, it can be felt by a doctor by pressing on the labia), you cannot push.